Why Are Ultrasound Machines So Expensive?

Few days ago we visited a company that makes avionics for small private planes. I looked at the hardware, a simple touch screen and tiny linux computer with usual sensor connections. I thought I could build this myself in a weekend for may be $300 tops which is an order of magnitude lower than their sell price. However what I learned was that the thing is expensive is not because hardware or software is expensive but the <i>QA</i> and <i>certification</i> process. There are regulations that avionics needs to work in all kind of weather at wide range of temperatures and pressures while still being accurate and have million hour of run time testing without any crashes and survive extreme shocks, vibrations and G-forces. Someone is after all betting their lives on your device. Now suddenly you have to care about strength of every soldering joint, specs of every transistor and reliability of every screw. Add on to this the customer support, marketing, warranties, legal expenses, returns and other typical overhead of production. If I&#x27;d to make device that is compliant of all these, it wouldn&#x27;t come cheap. Making a hobby device for demo to school kids is quite different than making device that would help people make life and death decisions.

&gt; A 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.<p>This is ridiculous. Transmitting needs a good amount of energy for a high number of channels (several dozen, and quite often &gt; 100), and at a high frequency. And if you are driving a 10MHz transducer, you will for ex drive it with a 80MHz numeric signal (at least when using a low number of levels, which you often wants to in order to keep an high efficiency for the relatively high power TX)... Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about.<p>Reception is also not trivial at all, if you want a decent quality. You also sample at a rate &gt; to the centre frequency.<p>Of course you might be able to construct an amateur toy low-end ultrasound machine, but it would be of no clinical value (and of limited value for a lot of other purposes too). Also without extensive measurements, you should not use your resulting machine on any living thing...

I like free software as much as the next guy, but saying, &quot;If there were free software for this project, the cost would come down.&quot; ignores that developing that software is expensive and someone needs to pay for it.<p>From an economic perspective (and this article is about economics), companies release software when they hope that the cost of the freeloaders is outweighed by the number of benefit additional contributors will provide. (Or that broad adoption of the software has some other benefit to the opening company.)<p>Generally, the more broadly useful the software is, the more economic sense it makes to open the source.<p>I see no evidence that there would be any economic benefit for any company opening the source of their very specialized, very expensive software here.<p>So yeah, if it were free, it would cost less. OK then.

There&#x27;s a lot of nitpicking about the details going on in this thread, and it&#x27;s very interesting to read.<p>But I think the gist of the post is that the hardware cost of a high end ultrasound unit is rapidly decreasing due to advances in ADC technology and the general trend of moving more and more functionality into DSP that used to require specialized analog circuitry.<p>For example, I recently bought a 20MHz spectrum analyzer and oscilloscope with built-in tracking generator for $145. Gear of similar quality would have cost tens of thousands of dollars just a decade ago.<p><a href="https:&#x2F;&#x2F;www.amazon.com&#x2F;gp&#x2F;product&#x2F;B018XD6Z5O&#x2F;ref=oh_aui_search_detailpage?ie=UTF8&amp;psc=1" rel="nofollow">https:&#x2F;&#x2F;www.amazon.com&#x2F;gp&#x2F;product&#x2F;B018XD6Z5O&#x2F;ref=oh_aui_sear...</a>

I do synthetic aperture radar signal processing for a living. I make the SAR pictures you see (or use for your research). I think a big part of the cost is the signal processing. You need fast A&#x2F;D converters too. The software though to make a steerable ultrasound beam is not trivial by any means. Also, you have multiple sound speeds to account for in layered media where you dont know the layers occur or what their sound speed is. Another really hard problem.

TL;DR there isn&#x27;t enough demand for specialty materials fab (PZT thin films for mHz range transducers) to benefit from economies of scale.<p>Other stuff (software, controllers) is also expensive, but it&#x27;s probably a fraction of the transducer cost so buyers tolerate it in order to get manufacturer support&#x2F;service contracts

The reasons ultrasound machines are expensive are not technical, it&#x27;s mostly low volume and high overhead to comply with all rules and regulations.<p>You can make a useful ultrasound machine with just one transducer (e.g., to measure blood flow through the heart using Doppler, or using mechanical scanning).<p>You don&#x27;t need fast CPU for processing, just downconvert to audio range and then 80286 is fast enough.<p>Source: wrote embedded software for one of those machines back in the day. 16 kB for everything, from keypad debouncing to GUI.

I&#x27;ve been researching diagnostic medical equipment a lot recently, and it seems like the biggest barrier to homebrew medical diagnostic equipment is attitudinal. Discussion about building your own equipment are almost immediately sidetracked by FUD about how dangerous it is.<p>Proper medical devices have loads of safety features! They have isolated power supplies! They are tested in harsh environments! They fail in a predictable manner! There are regulations that need to be followed! New devices are still expensive because they are better!<p>Yes, electricity can kill you.<p>Yes, improper medical advice can kill you.<p>Yes, malfunctioning diagnostic equipment can lead to an incorrect diagnosis, which, yes, can kill you.<p>Yes, medical regulations exist and protect us from harm.<p>While a homebrew machine would not be able to compete with the latest and greatest, I&#x27;d hazard that even rudimentary diagnostic equipment could save thousands of lives a year in the developing world. These technologies are not new -- the medical ultrasound has been around for more than 60 years, and the EKG has been around for nearly 100. It seems insane that cost is still such a barrier for the machines used for medical diagnostics, when the price of other technologies has fallen so much in the same period of time.<p>I bought myself a Rigol DS1054Z, and I realized that I paid $400 for an oscilloscope that would have cost millions of dollars 30 years ago. I thought about the experiments I had done on neurons using the 50 year old oscilloscopes as part of my degree, and I realized that an ECG&#x2F;EKG can be replicated pretty easily with an oscilloscope. It turns out, building an ECG is pretty trivial. It&#x27;s not a 12-lead ECG, but it&#x27;s also something I built out of parts I had on hand.<p>I don&#x27;t see why other medical technology should be any different. Yes, unregulated medical technology <i>is</i> dangerous, but the risk doesn&#x27;t seem to outweigh the potential benefit. If the parts to build these devices is cheaper and more accessible than they ever have been, and the equipment needed to build, test and calibrate the devices is cheaper and more accessible than ever, it seems like the devices themselves should be cheaper and more accessible than ever. I think there is a place for a $20k ultrasound, but when you live hours or days from an ultrasound, a cheaper option could save lives, even if the primary purpose is directing people to get a follow-up with the more capable machine.

Low unit test equipment is always expensive, see also: Oscilloscopes, Spec Analyzers, etc.<p>You just don&#x27;t see the volume that makes economies of scale kick in over your NRE(non-recurring engineering) costs.

The FDA process is also extremely expensive. Not saying it justifies cost, but it is a significant upfront investment of time. Additionally, updates to the device over time have to go through approvals again.

I&#x27;m going to be a cardiology fellow at Stanford in July, we use ultrasound often for both bedside informal exams as well as diagnostic echocardiogram. I&#x27;ve used handheld devices like the Lumify and Vscan, as well as the large tractor sized epiq machines. Similar to what is written in the article, my impression is that the actual hardware, specifically the transducer, is quite expensive to manufacture. The software and processing power continues to get cheaper but to have to best quality pictures, require expensive transducers. I&#x27;ve actually been very very impressed by the Lumify and I think it is getting near if not better than the quality of the gigantic epiq machines, primarily by having a very high quality transducer. This is indeed a hot area and knowing people who are actively doing development in the field, there are poeple trying things like having a giant paralleled transducers over the entire chest for continuous 3D images and other interesting ideas that are limited more by hardware than processsing power or imagination.

If you want to improve ultrasound, combine it with the positioning sensors of a VR system so the position of the sensor is known. Then you can do full tomography and build up a 3D model as the sensor is run over the body. For extra points, have alignment sticker targets you can attach to the body to track the patient if they move. Veterinarians would go for that.

It&#x27;s probably worth mentioning that relatively low-cost and mobile ultrasound machines exist. One company just recently received FDA approval for a wireless ultrasound machine. Target price seems to be ~7k to ~10k<p>See news here: <a href="http:&#x2F;&#x2F;www.mobihealthnews.com&#x2F;content&#x2F;clarius-mobile-health-gets-fda-clearance-app-based-wireless-ultrasound-scanners" rel="nofollow">http:&#x2F;&#x2F;www.mobihealthnews.com&#x2F;content&#x2F;clarius-mobile-health-...</a><p>See company website here: <a href="http:&#x2F;&#x2F;www.clarius.me&#x2F;" rel="nofollow">http:&#x2F;&#x2F;www.clarius.me&#x2F;</a>

When cheap unregulated Chinese clones start coming out of ultrasounds like this one: <a href="http:&#x2F;&#x2F;intelametrix.com&#x2F;FullSite&#x2F;" rel="nofollow">http:&#x2F;&#x2F;intelametrix.com&#x2F;FullSite&#x2F;</a> thats when you know ultrasounds can be cheap.

Aside from the technical issues with the machine, ultrasound imaging is harder to perform (in terms of scanning technique) and very difficult to interpret compared to a high-resolution MRI or even simple X-ray. It takes significant training to even <i>find</i> specific organs, and distinguishing between, eg, a gas bubble in the small intestine vs a potentially dangerous foreign object or even a tumor takes a lot of education and experience.

What I find missing from this discussion is the safety aspect of wholesale ultrasound. Yes, we&#x27;ve been told they&#x27;re perfectly safe. That was once said of x-rays as well and physicians were routinely x-raying fetuses in the uertus up until the 1970&#x27;s. That was before the evidence of birth defects from exposure to x-rays became so overwhelming that the practice finally stopped.<p>See <a href="http:&#x2F;&#x2F;sarahbuckley.com&#x2F;ultrasound-scans-cause-for-concern" rel="nofollow">http:&#x2F;&#x2F;sarahbuckley.com&#x2F;ultrasound-scans-cause-for-concern</a> and references quoted therein for a good overview of the current discussions on side effects of routine ultrasound screening, including tissue damage due to cavitation and hearing loss in fetuses.

Previous discussion:<p><a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=11156288" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=11156288</a>

The regulatory burden is not so high that it can be attributed to the cost of most USS machines - thats just a mirage created by the large corporates who want to defend their place in the market. This isn&#x27;t just seen in medical ultrasound, but across healthcare.<p>The regulatory and evidence burden is hard - but its not insurmountable and it certainly shouldn&#x27;t stop change.

I don&#x27;t have experience with medical ultrasound, but I have built a few basic ultrasonic systems around a PC or a single board computer for structural testing applications. If you&#x27;re not doing phased array ultrasonics you can build a system for under $1000USD, possibly less if you can use PVDF instead of PZT. The expensive part is the software.

The cmut or pmut transducer array, supporting hardware, onerous regulatory environment, and price elasticity in Western medicine.

I like the question, its worth asking as technology improves. There are lots of great comments too about the challenges that are non-trivial. Generally my use of ultransonics has been constrained to robotic localization and party tricks but imaging is an interesting question too.<p>Arrays of sensors is still hard, driving them, reading them, and interpreting them. That particular engineering problem hasn&#x27;t gotten that much easier.

I met a guy in Chennai, India who sold Ultrasound machines some time back. On enquiry I learnt they don&#x27;t sell any of the big brands cause they cost in millions and can&#x27;t be afforded by most semi-urban or rural health facilities.<p>Instead the one they sell is locally made and costs around 10K tops. He did claim there is not much tech on these devices and I took him at his word then. It makes sense now.

What about emerging markets? If they are so expensive, they probably don&#x27;t have access to them. Low cost, low performance medical devices that target emerging markets seem like a great area to invest massive amount of money into with a realistic chance of generating revenue.<p>Beware: Just my thoughts, i really don&#x27;t know much about the market and the money needed. I am probably wrong.

Having been involved in designing and building ultrasound systems for a couple of decades, I thought I&#x27;d comment on this in a blog post for those looking for a little more detail on the issues involved in building and selling ultrasound devices for medical use.<p><a href="http:&#x2F;&#x2F;liesandstartuppr.blogspot.com&#x2F;2016&#x2F;12&#x2F;why-are-medical-ultrasound-systems-so.html" rel="nofollow">http:&#x2F;&#x2F;liesandstartuppr.blogspot.com&#x2F;2016&#x2F;12&#x2F;why-are-medical...</a><p>A quick summary - they&#x27;re not expensive, in fact for what you get they are remarkably inexpensive. There&#x27;s a huge amount or work that goes into them, and the author of the original piece simply doesn&#x27;t even know enough about the subject to realise he doesn&#x27;t know what he&#x27;s talking about.

Having started my career making military radars, I&#x27;ve always been amused by tourists that criticize the cost of products that are required the have extreme performance and reliability in industries that are highly regulated to ensure compliance. The best simple explanation I&#x27;ve ever seen for the seemingly excessive cost was from an episode of West Wing:<p><a href="https:&#x2F;&#x2F;youtu.be&#x2F;7R9kH_HOUXM" rel="nofollow">https:&#x2F;&#x2F;youtu.be&#x2F;7R9kH_HOUXM</a><p>While an ashtray may seem trivial, this example shows that in life-or-death situations, every detail must be considered and doing so is not cheap.

One thing that is perhaps not obvious - while the rapid iteration of constituent parts has, for example, driven a lot of consumer gear prices incredibly low, one reason for it is that vendors can rapidly rework device internals to capture cost savings due to new part supply.<p>In medical devices this doesn&#x27;t really work, and actually becomes more of a problem than a benefit, at least currently. You cannot change the constituent parts of your device without a lot of work, so a rapidly iterating supply can cause you trouble with getting a stable supply of parts for several years. This is (only) one of the reasons that medical grade monitors are so much more expensive than you might expect.

I am wondering if anybody knows of an open-source project focused on designing the hardware and software for “recreational” ultrasound machines. I think like 3D printers (reprap etc), there would be a sizable group of hobbyists and tech savvy individuals in the medical community who would be interested. I don’t know quite enough about the electronics to initiate something like this but would definitely pitch it.

And if the botched together ultrasound machine misidentifies a thyroid nodule, leading to it not being FNABed, you are looking at a possible death from thyroid cancer...

I think such a project would be very important for underserved areas in human and vet medicine. Having a portable ultrasound is invaluable in diagnosing many conditions.

Make a cheap ultrasound device for non-medical use, and let people use it at their own risk. This will still save many lives, especially in poor countries.

Products are sold for prices the market will bear, which is only loosely related to the cost of making them.<p>Or rather - if you sell a fixed number of items and could only reasonably justify a certain margin, then you <i>don&#x27;t want to make it cheaper</i>.<p>If barriers to entry are high - then you sit on your cash cow.<p>This issue is very prominent in healthcare for both services and equipment.<p>It&#x27;s a very costly problem.<p>Insurance companies want your bill to go up, not down, so they don&#x27;t act as aggressively as they could to cut costs for small items. Hospitals - same.<p>Because of the vast costs associated with regulation, overhead, marketing and near monopoly on many products, combined with massive &#x27;price inelasticity&#x27; on part of the buyer (i.e. you&#x27;ll pay &#x27;whatever&#x27; to get fixed) - you get a problem.<p>My parents both worked in pharma, it&#x27;s an industry flush with cash - they spend big on everything, offices, equipment, staff. They have a doctors sense of entitlement - after all - they are &#x27;saving lives&#x27;. And it is serious business, you can&#x27;t hack your way through most of it.<p>So as the underlying expenses and regulatory costs go up - so do all the ancillary costs. Add that to the misaligned market incentives and price inelasticity ...<p>And you get unbelievably expensive healthcare.<p>I firmly believe you could train a smart person to do an x-ray and to reset a bone, put on a cast and to it for under $1K. And it would cost $10K probably in a hospital sans insurance.<p>Now - the first &#x27;problem&#x27; in that scenario is that doctors are often paid to be good &#x27;when things go wrong&#x27;, and to get their yield way up (i.e. can&#x27;t make mistakes) and both of those things are very expensive: you need to have 10 years of &#x27;extra training&#x27; for the 1% of the time something weird happens.<p>Fair enough - but I still think many of those things can be parameterized.<p>Costs will not come down until their is an agent forcing it: the government, or preferably, another kind of provider.<p>Wallmart has an approach to business like no other: they force their suppliers to open their books a bit, force their costs down - and then pass all the savings onto the consumer. It&#x27;s something few understand. Their strategy is volume, and they have an ethos of sucking producer surpluses right out of the value chain.<p>If Wallmart could feasibly get into the healthcare game on the low end, it could send waves right through the industry, which would be good.

Alibaba sells fully featured non-fda approved (usually) veteranary ultrasound machines for as little as $800 USD - this includes a monitor and control panel etc. That is probably pretty close to commodity pricing for a specialised device.<p>There are also wireless ultrasound probes for around $800 USD - these could potentially come down in price too.<p>The reason commercial ultrasound sound machines cost 50-500k is that hospital are paying for:<p>- a brand name with reliability behind it<p>- the ultrasound rep to come and demo the machine a few times before and after it is purchased, as well as bring in some platters of food. Also the ultrasound machine reps also bring additional machines along for courses in use of the ultrasound for intern teaching etc.<p>- a support contract<p>The cheap, ubiquitous ultrasound machine seems like a great idea, and is useful in some settings (like ER especially), however there are some significant issues - probably best understood with the example of echocardiography.<p>Performing an echocardiogram (ultrasound of the heart) is a highly specialised field with neverending levels of complexity. Firstly, you are often dealing with inadequate images due to the patient&#x27;s obesity or other anatomical factors, therefore less experienced operators get worse images which can make interpretation impossible. Even when you do get good pictures, it is a very subjective area and 2 operators will commonly have divergent results for the same scan. Thirdly the there are dozens and dozens of parameters which can be measured or calculated which are used as surrogates for functional measurement of the heart - these are being proven or disproven&#x2F;or becoming fashionable or falling out of fashion over time.<p>Practicioners need to perform a certain number of echos per year to maintain base competency, and those with low numbers generally perform much worse than those who do echos every day.<p>A quick, goal directed, focused echo can yield useful results, and does work a lot better than a stethoscope, but then many would argue that allowing allcomers (physicians&#x2F;ED docs&#x2F;anaesthesiologists&#x2F;ICU docs) to perform poor quality scans is a step back from having more specialised doctors performing fewer, high quality scans.<p>So overall, the issue is probably not that the machines are too expensive, it is that we have not worked out exactly who should be doing these scans. The truth lies somewhere between a very few people (ultrasound trained cardiologists&#x2F;radiologists) and everyone, but we are not sure exactly where.<p>Overall I think that the technical advances here will not come from building cheap open source ultrasound machines (although it does sound fun!), but from improving ultrasound machines in their ability to acquire and interpret pictures themselves. This may be by having a remote telesonographer that guides and interprets a scan performed by a layman (eg a nurse) which would allow rapid, remote results without the telesonographer present (and could also allow utilisation of excess sonographers in some locations to places where they are scarce, or allow daytime sonographers on one side of the world to help scan patients at 3am on the other side, or allow utilisation of outsourced remote indian&#x2F;filipino sonographers for cost savings.<p>Alternatively, new tech would perform scans automatically (eg. robotic arms, or human operator guided with instructions or haptic feedback) and then do tech guided interpretation - eg. generate all the important data from the information given and present it at a level appropriate to the person requesting the scan.