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Why Are Ultrasound Machines So Expensive?

195 pointsby grahar64about 9 years ago

25 comments

skaabout 9 years ago
The cost of components is often not a big part of the cost of producing an imaging device like this. Building hardware and software in a regulated market where human safety is involved requires levels of validation, verification, process control, risk analysis and documentation that can easily dwarf component cost at the sort of run sizes we are taking about.<p>This isn&#x27;t the only thing going on, but it is naive at best to think of the price of these units as a parts list.
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atourgatesabout 9 years ago
All medical technology is insanely expensive.<p>My wife is an ophthalmologist in private practice, and we&#x27;ve spent far too much money on diagnostic equipment.<p>My most frustrating single experience was spending $18,000 on a refurbished visual field last year (the machine where you see flashes of light in your peripheral vision and push the button), and having it show up running a custom version of Windows 3.1 and an actual honest-to-god 3.5&quot; floppy drive.<p>My current project is trying to figure out how to get digital visual testing systems (e.g., eye charts on a monitor) setup in her exam rooms. If I were to buy a system from a medical distributor, I&#x27;d be spending something like $2,000 - $4,000 per room.<p>With an Atom-powered mini-PC, I could get Windows hardware and a monitor setup in every room for about $300&#x2F;room. I was hoping I&#x27;d be able to find some open-source visual acuity software, but it doesn&#x27;t seem to exist. Most software-only solutions are still over $1,000 per-license per-room. The best-looking and most reasonably priced Windows software I&#x27;ve found is $400&#x2F;room. Bringing my total cost to a (somewhat painful) ~$700&#x2F;room.<p>There is one piece of good Visual Acuity software in the Mac App Store[2] that we&#x27;d be able to deploy in all 4 of our exam rooms with a single $99 license. So with 4x Mac Minis plus monitors, our per-room price would be pretty close to $700&#x2F;room going that way too. But it seems like such a waste to spend $500 on a Mac Mini that will do nothing besides display some letters and symbols.<p>What I&#x27;d love to see is industry associations working together to produce open source software that solves problems like this. Visual testing software isn&#x27;t complex. A fairly reasonable investment could get something open source developed that would lower the cost of healthcare across the country, and worldwide.<p>There are about 58,000 Ophthalmologists and Optometrists practicing in the United States. If we assume they average 2-lanes each, and open source software could lower the cost of visual acuity testing in each lane from $2,000 to $300, that would save $98-million.<p>1. <a href="http:&#x2F;&#x2F;konanmedical.com&#x2F;chart2020&#x2F;" rel="nofollow">http:&#x2F;&#x2F;konanmedical.com&#x2F;chart2020&#x2F;</a> 2. <a href="http:&#x2F;&#x2F;www.kybervision.com&#x2F;mac&#x2F;visualacuity&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.kybervision.com&#x2F;mac&#x2F;visualacuity&#x2F;</a>
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taconabout 9 years ago
A few years ago, my patellar tendon was getting sore from running, and I went to a sports medicine specialist. At that first visit, he did an ultrasound scan over the length of my patellar tendons, and it was very discouraging to see these &quot;black&quot; sections in the mid-core of my tendons. They were actually tissue that was a bit disrupted, but the way it scattered the sound, it appeared as &quot;black&quot;. Kind of freaked me out that my tendon was &quot;dead&quot; in the middle. The actual diagnosis was patellar tendinopathy, previously referred to as patellar tendinitis, or &quot;jumper&#x27;s knee&quot;.<p>He gave me exercises to build up my tendons, mainly eccentric resistance exercise, but it was going to take a long time. I wondered how I could monitor the progress of the healing. The doctor visit and scan was at least $200&#x2F;visit, and the healing could take a year. On AliBaba, I checked how much a low end machine would cost to use at home.<p>There were all sorts of machines available, and one manufacturer&#x27;s rep latched onto me. I still get the occasional email checking if I&#x27;m ready to buy. I think these machines may require some doctor&#x27;s approval, too, but I never went that far.<p>But they sure don&#x27;t cost anything like the prices in this article. In 2013, for quantity 1, IIRC, I was quoted $1100&#x2F;each for this SUN-806F laptop plus sensor plus software unit:<p><a href="http:&#x2F;&#x2F;www.cnsunbright.com&#x2F;china&#x2F;english&#x2F;newshow.asp?Cid=108&amp;sid=149&amp;PID=135" rel="nofollow">http:&#x2F;&#x2F;www.cnsunbright.com&#x2F;china&#x2F;english&#x2F;newshow.asp?Cid=108...</a><p>Maybe I&#x27;m missing something critical in this price difference? As the OP was explaining, you can almost build one yourself.
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m0lluskabout 9 years ago
The current heavy hitter in the ultrasound industry is Zonare and the Zonare Technology page (<a href="http:&#x2F;&#x2F;www.zonare.com&#x2F;technology&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.zonare.com&#x2F;technology&#x2F;</a>) indicates that they are providing state of the art ultrasound that is much faster and higher resolution than earlier systems by combining variable sets of observations. This indicates that the technology that is currently being purchased and used is substantially more complex than a mere sensor.<p>Additionally medical markets have very complex purchasing processes and criteria that require specific marketing strategies to market. Most startups are used to going for cheap or fast or both, but medical markets want good and are not nearly as sensitive to price or delivery time. To sell to medical markets it is necessary to convince medical equipment purchasers that an option is better and less risky than other possibilities.<p>Overall this thread is a shameful display of the shallowness and shortsightedness of startup engineering today. The answers to most of the questions raised here can be answered by the technology page of the dominant supplier, but no one bothered to look up any of that. Instead we get irrelevant broken foot anecdotes. Conversationally that may make sense, but realistically making the kind of ultrasound machine offering that doctors might want to use and be able to buy is a very different and more complicated problem than is suggested by most of this thread.
smoyerabout 9 years ago
I designed an opthalmic ultrasound in the late &#x27;80s. The article describes &quot;b-mode&quot; ultrasound which actually creates an image (in some fraction of a circle like you see when someone shows you their unborn child). Back then, the electronics to electrically steer the beam were very hard to create (20MHz was a fast clock back then) and so the b-mode transducers were often mechanically steered. there was one transducer that was moved in an arc by the steering motor and coupled to an acoustically transparent housing by some gel.<p>Central Pennsylvania (from whence I&#x27;m writing tonight) played a key role in the creation of ultrasound systems - and Johnson and Johnson still manufacturers their transducers about 15 miles from where I&#x27;m sitting. The technology originally developed for SONAR came to the Pennsylvania State University where some of the engineers though of cool other ways to use transducers. Good thing the human body has so much water (or other components with a similar density and propagation speed.<p>When you get a b-mode ultrasound, you see the interface between two types of tissue (or bones) due to reflection. If you look at an image, it takes some practice to even &quot;see&quot; what the picture is.<p>So back to the cost issue - the biggest single expense in creating an ultrasound unit was getting through the FDA approval process. It was grueling - requiring a lot of testing by outside laboratories and a lot of internal engineering time for paperwork. Once you start to manufacture them, you&#x27;re making (for a small company like ours) hundreds of units and even the large manufactures aren&#x27;t making them like the Coca-Cola company spits out cans of soda. You&#x27;re amortizing a lot more development costs into each unit.<p>And then, once you start selling to hospitals and doctors offices, the mark-up is huge. They in turn pass a large chunk of the cost of the machine to the insurance companies. If you were charging $500 per scan 20 times a day, you&#x27;d pay for your $8000 machine pretty quickly).
asmithmd1about 9 years ago
There are Chinese made 3D machines for sale on EBay for less than $1000:<p><a href="http:&#x2F;&#x2F;www.ebay.com&#x2F;itm&#x2F;Portable-Digital-Ultrasound-Machine-Scanner-System-3-5-Mhz-Convex-Probe-Free-3D-&#x2F;331342708500" rel="nofollow">http:&#x2F;&#x2F;www.ebay.com&#x2F;itm&#x2F;Portable-Digital-Ultrasound-Machine-...</a>
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dzhiurgisabout 9 years ago
Philips got a device called Lumify, starts at $199 but requires monthly subscription to use.
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revelationabout 9 years ago
If you&#x27;re patient, you might just find old machines (in some form of working order) show up on eBay and other marketplaces for old gear.<p>There is a video series of a teardown&#x2F;repair of an old baggage x-ray machine that was acquired this very way:<p><a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=KPyE29ABmoA" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=KPyE29ABmoA</a><p>In fact, looking through the other videos by the same guy, he seems to have a fair number of xray machines..
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esmiabout 9 years ago
I think the answer is simply NRE is amortized over a small number of units. This is the case for a lot of test equipment.
daeminabout 9 years ago
So my first job out of University was for a medical device startup, where the aim was to create a basic but inexpensive ultrasound (compared to huge &quot;portable&quot; ultrasound machines). They are still in business (I have friends still working there, 10+ years now) but for some reason they are not mentioned in any articles such as these, even though the product fits a lot of the requirements listed.
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c-sliceabout 9 years ago
Here are a few more reasons:<p>1) High touch sales process, slow sales cycles - ultrasounds take a long time to sell to hospitals&#x2F;clinics so the sales process is very high touch and requires a significant number of demos and in person time. Those sales reps are usually paid on commission. Cheap products don&#x27;t make sense to sell this way.<p>2) Lack of competition and high development cost - Ultrasound machines are a Class II medical device and so are regulated by the FDA. FDA requires compliance with most relevant ISO standards, and there would probably be a dozen relevant standards for an ultrasound machine.<p>3) Liability - complex medical devices that are used for critical diagnoses create big liability problems for the hospitals&#x2F;clinicians. They have no incentive to choose the low-cost model sold by a startup. No one ever got sued for choosing GE&#x2F;Philips&#x2F;etc.<p>4) Lack of price transparency - its often hard to find prices for big ticket medical devices, so the natural pressure to reduce costs through competition isn&#x27;t as effective, especially with a high touch&#x2F;high cost sales process.
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rdtscabout 9 years ago
Ultrasound machines of some sort is also pretty popular startup idea. I&#x27;ve heard at least of 3 people through personal connection who were building some sort of &quot;ultrasound&quot; device based startups. All have had proof of concepts and all have failed. I am guessing failing to deal with regulation, and other such red tape.
z3t4about 9 years ago
When I was in the training business I was thinking of buying an ultrasound device. Yes, they are expensive, but the hardest part is you need a lot of training, even if you know your anatomy by heart, it&#x27;s hard to make something out of the image.<p>I think it can be greatly improved by better software, so it get&#x27;s closer to an MRI.
n00b101about 9 years ago
To answer the question, it is because OP (Graham) hasn&#x27;t created a startup to solve this problem.<p>When my wife was pregnant we went to a lot of ultrasounds, and I observed those big Phillips machines very closely, they definitely have room to improve on multiple dimensions.
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mathattackabout 9 years ago
They could just as well be asking, &quot;Why is Salesforce so expensive when the marginal cost of each additional user is negligible?&quot;<p>The answer is that the market price reflects a lot of other costs than just parts for adding an incremental user.
madengrabout 9 years ago
10 years ago when my wife was pregnant, a dianostic ultrasound cost $800, took 15 minutes, and the machine looked ancient. A 3D &quot;fun scan&quot; was $150, took 1 hour, and the machine was state of the art. Go figure.
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spyderabout 9 years ago
<a href="http:&#x2F;&#x2F;www.dailymail.co.uk&#x2F;health&#x2F;article-2203114&#x2F;Pregnant-wife-inspires-engineer-build-affordable-hand-held-baby-scanner-save-thousands-lives.html" rel="nofollow">http:&#x2F;&#x2F;www.dailymail.co.uk&#x2F;health&#x2F;article-2203114&#x2F;Pregnant-w...</a><p><a href="https:&#x2F;&#x2F;vimeo.com&#x2F;49436607" rel="nofollow">https:&#x2F;&#x2F;vimeo.com&#x2F;49436607</a><p>Looks like they use one or just a few transducer and move it manually to reduce the cost.
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ck2about 9 years ago
They wanted $600 to ultrasound me when I had gallstones, it&#x27;s a racket.<p>Had to skip on that and just ate more fiber instead which thankfully solved that (pain was unbelievable).
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raverbashingabout 9 years ago
&quot; computer that can run a MHz frequency transducer is easy and cheap these days, e.g. a raspberry pi’s GPIO pins can run that frequency.&quot;<p>Yeah, but actually you need an ADC that runs at MHz frequencies and a frontend amplifier to capture the signal and put it into the ADC<p>Definitely this falls into the &quot;not expensive&quot; category, but not in the &quot;trivially cheap&quot; one
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ChicagoBoy11about 9 years ago
This is a phenomenal article outlining how the regulatory environment essentially causes these devices to be far more expensive than they really ought to be:<p><a href="http:&#x2F;&#x2F;faculty.chicagobooth.edu&#x2F;john.cochrane&#x2F;research&#x2F;papers&#x2F;after_aca.pdf" rel="nofollow">http:&#x2F;&#x2F;faculty.chicagobooth.edu&#x2F;john.cochrane&#x2F;research&#x2F;paper...</a>
go13about 9 years ago
Can anybody who is knowledgeable in this area tell me if it is possible to use later interference to build ultrasound transducer? Similar to how gravity wave detector works but for 2 dimensions?
datenwolfabout 9 years ago
Actually &quot;Ultrasounds&quot; are among the cheapest medical devices around. Practically &quot;everybody&quot; makes them and the market is oversaturated.<p>The processing software is actually the least problematic thing; it&#x27;s all well documented and somebody with the right background (electronics, digital signal processing and computer graphics) could hack it in a single weekend (that&#x27;s not an exaggeration: When I got invited to the group where I&#x27;m currently doing my PhD they were giving me a few datasets of raw, unprocessed Swept-Source OCT fringe data and said &quot;have fun&quot;. A day later, using liberal application of NumPy I got pictures; another day and the quality was pretty good.<p>&quot;Ultrasounds&quot; cost more than consumer goods, because, at the moment, they are not consumer goods. Compare this to the cost of &quot;personal computers&quot; in the 1980-ies. Just about as expensive, and &quot;Ultrasounds&quot; are kind of the medical imaging &quot;PC&quot; counterpart for general practitioners.<p>So can &quot;Ultrasounds&quot; be made consumer goods? Difficult, because some parts of them must be built at very high quality standards, not to put the patient at risk. Also some of the electronics involved is challenging, even by todays standards. For example driving the transducers requires driving amplifiers capable of outputting &gt;1kV against a highly complex and poorly matched impedance at bandwidths above 1MHz. That&#x27;s a really tough problem, that, luckily, has been solved but still requires fairly complex electronics; you can buy appropriate driver amplifier ICs, but those are not cheap, often &gt;10$ per Unit and you need several of them. But that&#x27;s only half the story: You also need to receive the reflected signal. Here&#x27;s the problem that the transducers tend to ring after emitting the pulse, causing signal artifacts. And the waves coming back will produce only a few µV of signal. So you&#x27;ve got a 180dB dynamic range between sending and receiving and TX and RX share parts of the signal path; either your RX amplifier can cope with the 1kV sending signal and quickly enough recovers, or you have to add some fairly quick, high insulation signal path switches to quickly switch between TX and RX.<p>And finally you need a whole array of medium speed ADCs (each with a sampling rate of about 10MHz to allow for some oversampling) one for each channel; and of course the interface to the computer. A single 10MHz ADC is cheap. But as soon as we enter the multiple channel interfaces domain things get pricey quick. Just look at audio which operates at most at nimble 96kHz, yet &quot;pro-sumer&quot; (enthusiast consumer) audio interfaces with 16 or more channels go over 1000$; And we need 100 times the sampling rate for ultrasound. So actually the about 3000$ you pay for the ADCs is pretty cheap, if you compare the MHz&#x2F;$.<p>So you&#x27;ve solved all these essential problems. Now you have to make sure, that a mechanical failure doesn&#x27;t expose the 1kV driving signal to the transducer to the patient. Here&#x27;s the challenge: The transducers are separated by the thinnest possible layer of isolation material from the patient&#x27;s skin, there&#x27;s a pulsed &gt;1kV amplitude AC signal right behind it, and between the probe and the patient you have conductor gel, which is essentially water jelly, that gives a nice acoustic impedance match, but also does a very good electrical match; we&#x27;re talking body resistivity model in the two-digit ohms right now. Or in other words: A single manufacturing failure in your scanhead probe and you&#x27;re going to electrocute the patient. Oh, you&#x27;re thinking about just floating the whole transducer driver electronics. Smartass, that won&#x27;t work, because you&#x27;re operating with MHz AC here, so we&#x27;re talking RF coupling, driving transducers with significant pulse power; you&#x27;ll giving your &quot;victim&quot; RF burns, which are nasty.<p>Come to think about it: 8000$ for a ultrasound imaging unit sounds pretty cheap.
awqrreabout 9 years ago
Buy it from unregulated Chinese providers for personal use?
tlarkworthyabout 9 years ago
Compared to an MRI machine it&#x27;s very cheap
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vacriabout 9 years ago
&quot;Why is custom software so expensive to produce? Open-source components are <i>free</i>, so the final product should be, too!&quot;