14 ms·

Why Are Ultrasound Machines So Expensive?

195 points by grahar64 11y ago

tacon 11y 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 "black" 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 "black". Kind of freaked me out that my tendon was "dead" in the middle. The actual diagnosis was patellar tendinopathy, previously referred to as patellar tendinitis, or "jumper's knee". 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/visit, and the healing could take a year. On AliBaba, I checked how much a low end machine would cost to use at home. There were all sorts of machines available, and one manufacturer's rep latched onto me. I still get the occasional email checking if I'm ready to buy. I think these machines may require some doctor's approval, too, but I never went that far. But they sure don't cost anything like the prices in this article. In 2013, for quantity 1, IIRC, I was quoted $1100/each for this SUN-806F laptop plus sensor plus software unit: http://www.cnsunbright.com/china/english/newshow.asp?Cid=108&sid=149&PID=135 http://www.cnsunbright.com/china/english/newshow.asp?Cid=108... Maybe I'm missing something critical in this price difference? As the OP was explaining, you can almost build one yourself.
- acqq 11y ago
  So it was 3300 USD total for the solution? And the interesting detail, in the article that the author links there is this opinion from the doctor who uses the portable ultrasound device: http://www.kevinmd.com/blog/2014/05/pocket-ultrasound-machine.html http://www.kevinmd.com/blog/2014/05/pocket-ultrasound-machin... "Other doctors often ask me if I bill for my exams. I don’t, because billing and the detailed documentation and posturing that would be necessary to prove to an insurance company that an ultrasound was necessary would take more time than I have." The rest of the article is also insightful.
- grahar64 11y ago
  OP/author here, I also have patella tendinitis since I dislocated my patella when I was 17. This is the reason I started looking at ultrasounds, I figured that I could buy one for the $160 cost to get a scan from a doctor. I have looked around for a cheap ultrasound, but $1100 is far cheaper than I was able to find (I got to about $3k but looked like a dodgy dealer so didn't link to it). But 1k is still way more expensive than I think it should be. It should be a sensor you just plug into and iphone for a few hundred. I mean there is the http://www.thermal.com/thermal-cameras/ http://www.thermal.com/thermal-cameras/ thermal camera for only $250, why not ultrasound? Making a photo sensor must be thousands of times more complicated than ultrasounds sensors. I just want to know why I can't buy one cheaper than my massively more complex iphone :)
  - sithadmin 11y ago
    >Making a photo sensor must be thousands of times more complicated than ultrasounds sensors. Cheaper thermal imaging sensors like that usually use a very, very low resolution sensor for picking up thermal data, then use interpolation to map the low-resolution data onto a high-resolution image provided by a higher-res conventional camera sensor. Obviously, this approach won't work with ultrasound tech, as there wouldn't be a secondary high-resolution data source.
    - grahar64 11y ago
      In the post there is a link to a paper where someone used a 40x40 array for 3d ultrasound imaging and there is a 64x array at 35MHz used for high resolution imaging of things like eyes. That is pretty low resolution for such interesting applications. Imagine the applications for a high resolution 3D ultrasound scanner combined with a high-resolution camera.
      - gene-h 11y ago
        It might be helpful to elaborate on what applications a 3d ultrasound scanner would have.
      - conceit 11y ago
- bduhan 11y ago
  A few months ago I almost ended up with a functional one from a local maternity ward for less than $100 on publicsurplus.com. I didn't realize the thing weighed =~ 400lbs until after bidding on it. Thankfully somebody else got the auction at the last minute.
n00b101 11y ago
To answer the question, it is because OP (Graham) hasn't created a startup to solve this problem. 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.
- spydum 11y ago
  Like a "post image to Facebook" or tweet this image button on the console? /s
esmi 11y 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.
ska 11y 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. This isn't the only thing going on, but it is naive at best to think of the price of these units as a parts list.
- ghaff 11y ago
  I agree with you but it can still be frustrating and there's a lot of entrenched interests involved. My story is that I broke my foot about 10 years ago (in the Grand Canyon no less). Long story short, when I eventually got the doctor, she told me that this kind of fracture always took a long time to heal and the literature suggested that electromagnetic stimulation had some benefit. Of course, the insurance company wouldn't pay until it was deemed a "problem fracture" in a few months (as my doctor thought it would be) but I did eventually get my $1000 stimulator at about 50% off. It had the most horrible interface one could imagine. If it slipped off the foot, it apparently simply shut down for that day's stimulation. In any case, my foot eventually healed. A few years later, a friend had a similar injury. I gave her my stimulator. Apparently the allowable stimulations had expired by then. She took it into a medical supply place and they were horrified by the idea that they might simply reset the device. I'm not a big pharma hater but this sort of story is why people get really mad.
  - tn13 11y ago
    Those ridiculous pricing policies are necessary to recover the cost of regulatory compliance which is seriously huge component of anything medical in USA. As a side note, I know a company in India that manufactured a state of art blood test device. They tried to market it in USA and eventually gave up. Currently the company has tie up with Singapore hospitals which send blood to India for testing via flight and reports are mailed electronically automatically. There is a rig of blood testing machines in Powai-Mumbai which tests thousands of blood samples each day. This machine clearly can not be sold in USA (last time I checked was 6 years ago) because the cost of regulatory compliance is prohibitive. If the medical device manufacturers indeed made windfall profits I would love to invest in their stock but they don't seem to be doing as well as the hatred directed towards them.
dzhiurgis 11y ago
Philips got a device called Lumify, starts at $199 but requires monthly subscription to use.
- grahar64 11y ago
  Cheers, that is awesome. Here is a video https://www.youtube.com/watch?v=HRLHtnza2jM https://www.youtube.com/watch?v=HRLHtnza2jM It seems very limited for purchase, but would be cool to get my hands on one. I added it to the post :)
atourgates 11y ago
All medical technology is insanely expensive. My wife is an ophthalmologist in private practice, and we've spent far too much money on diagnostic equipment. 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" floppy drive. 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'd be spending something like $2,000 - $4,000 per room. With an Atom-powered mini-PC, I could get Windows hardware and a monitor setup in every room for about $300/room. I was hoping I'd be able to find some open-source visual acuity software, but it doesn'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've found is $400/room. Bringing my total cost to a (somewhat painful) ~$700/room. There is one piece of good Visual Acuity software in the Mac App Store[2] that we'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/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. What I'd love to see is industry associations working together to produce open source software that solves problems like this. Visual testing software isn't complex. A fairly reasonable investment could get something open source developed that would lower the cost of healthcare across the country, and worldwide. 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. 1. http://konanmedical.com/chart2020/ http://konanmedical.com/chart2020/ 2. http://www.kybervision.com/mac/visualacuity/ http://www.kybervision.com/mac/visualacuity/
- deleted 11y ago
  [deleted]
- Aeolos 11y ago
  Fancy that, my current project is to create a low-cost, high-quality optical coherency tomograph for private practitioners. I am planning to open-source the software and, depending on how things turn out over the next few months, possibly also the hardware designs. This device can immediately detect around 80% of the pathologies of the posterior eye segment. It's high time we made this part of first-line diagnostic exams.
asmithmd1 11y ago
There are Chinese made 3D machines for sale on EBay for less than $1000: http://www.ebay.com/itm/Portable-Digital-Ultrasound-Machine-Scanner-System-3-5-Mhz-Convex-Probe-Free-3D-/331342708500 http://www.ebay.com/itm/Portable-Digital-Ultrasound-Machine-...
- grahar64 11y ago
  I commented on the post that you can get a thermal imaging camera that plugs into your iPhone for $250 http://www.thermal.com/thermal-cameras/ http://www.thermal.com/thermal-cameras/ . So I think that any price above that for a unit that looks like it has a CRT monitor from the 90's is a bit expensive. I just want one as a toy and to experiment with, and think the cost is out of reach of that.
- c-slice 11y ago
  There is 0 chance that a US hospital or clinician will risk using an off-label ultrasound machine from china on a single patient. It's almost guaranteed to not be FDA/CE approved. That's how you get a malpractice suit.
  - wongarsu 11y ago
    But the article also talks about the many other potential uses of ultrasound machines. For hobby use $1000 is still a bit steep, but for classroom use that might be doable.
  - randyrand 11y ago
    For low income uninsured folks, it could find use. Especially in lower income countries. America holds its self to such a high medical bar that many simply can't afford healthcare. That is unreasonable.
revelation 11y ago
If you're patient, you might just find old machines (in some form of working order) show up on eBay and other marketplaces for old gear. There is a video series of a teardown/repair of an old baggage x-ray machine that was acquired this very way: https://www.youtube.com/watch?v=KPyE29ABmoA https://www.youtube.com/watch?v=KPyE29ABmoA In fact, looking through the other videos by the same guy, he seems to have a fair number of xray machines..
- grahar64 11y ago
  How is that legal? :)
  - CamperBob2 11y ago
    Our (US) legal system doesn't work that way. If something isn't explicitly prohibited, it's permitted. This is a feature, not a bug. While it's not illegal to purchase and use an x-ray machine itself, it would be illegal to use one on human subjects without the proper training and licensing. (Unless, of course, you work for the TSA.)
m0llusk 11y ago
The current heavy hitter in the ultrasound industry is Zonare and the Zonare Technology page (http://www.zonare.com/technology/ http://www.zonare.com/technology/) 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. 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. 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.
c-slice 11y ago
Here are a few more reasons: 1) High touch sales process, slow sales cycles - ultrasounds take a long time to sell to hospitals/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't make sense to sell this way. 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. 3) Liability - complex medical devices that are used for critical diagnoses create big liability problems for the hospitals/clinicians. They have no incentive to choose the low-cost model sold by a startup. No one ever got sued for choosing GE/Philips/etc. 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't as effective, especially with a high touch/high cost sales process.
- Gibbon1 11y ago
  When I hear excuses about how some diagnostic test is expensive because the machines are expensive I think of airplanes and rental cars. So you say your ten year old ultrasound costs $50k? I can rent a $50k automobile for $150 a day, not for just ten minutes. And rent a space on a 120 million dollar airplane for a few hundred. And seriously, mom was an accountant. The capital cost of a $50,000 ultrasound machine is about $20/day. Meanwhile I have about $50,000 worth of test equipment sitting in my office. I'd never think of charging a customer a $2500 spectrum analyzer fee. Or a $400 oscilloscope diagnostic fee. Please.
madengr 11y ago
10 years ago when my wife was pregnant, a dianostic ultrasound cost $800, took 15 minutes, and the machine looked ancient. A 3D "fun scan" was $150, took 1 hour, and the machine was state of the art. Go figure.
- Gibbon1 11y ago
  Thing I harp on is that the medical industry is used to just charging whatever they can get away with. Since they have a generally naive and captive customer base, there is generally nothing to keep things real. My small experience with business is that when you have that situation you're set up to totally lose control of your costs. Because a lot of excess expenses are hidden in high margin products and services. Example, you make something for $5600 and sell it for $15,340. Could be that with a small amount of work you could produce the thing for $4200 ea. But because the margin is 'good' no one feels the need.
  - HeyLaughingBoy 11y ago
    Actually my experience with the medical industry is that products get "value engineered" to oblivion. They are acutely aware of their margins and are constantly trying to improve them by reducing costs where it doesn't affect performance.
    - Gibbon1 11y ago
      In some parts of the device industry there is actual competition though.
vacri 11y ago
"Why is custom software so expensive to produce? Open-source components are free, so the final product should be, too!"
mathattack 11y ago
They could just as well be asking, "Why is Salesforce so expensive when the marginal cost of each additional user is negligible?" The answer is that the market price reflects a lot of other costs than just parts for adding an incremental user.
tlarkworthy 11y ago
Compared to an MRI machine it's very cheap
- datenwolf 11y ago
  The funny thing about this is, that technologically an MRI is much simpler compared to an ultrasonic imager: - Field coil - Gradient coils + coil driver - RF transceiver (essentially n SDR) The single most expensive part is the cryostat for the field coil. If there were high temperature superconductors that would retain their properties within strong magnetic fields you could build and operate MRI scanners much cheaper. A few years ago I did build a very crude and simplistic MRI scanner in my shack; it had a piss poor resolution of about 10mm³ took "ages" to scan a single plane and would dissipate huge amounts of heat in the (normal conducting) field coil; the gradient coils were driven by a regular HiFi audio amplifier. But it is definitely possible to build such a thing DIY and have it produce images (of poor quality).
  - tlarkworthy 11y ago
    Wow that's really amazing. The super conductors are annoying in that they self distruct. I wonder if there is a cheap way to make one and gracefully shut it down when finished with it. I met one of the original engineers for ultrasound. The original design was 3d through mechanical scanning of the body
spyder 11y ago
http://www.dailymail.co.uk/health/article-2203114/Pregnant-wife-inspires-engineer-build-affordable-hand-held-baby-scanner-save-thousands-lives.html http://www.dailymail.co.uk/health/article-2203114/Pregnant-w... https://vimeo.com/49436607 https://vimeo.com/49436607 Looks like they use one or just a few transducer and move it manually to reduce the cost.
- kelu124 11y ago
  Indeed! That was a solution used 30 years back =)
awqrre 11y ago
Buy it from unregulated Chinese providers for personal use?
smoyer 11y ago
I designed an opthalmic ultrasound in the late '80s. The article describes "b-mode" 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. Central Pennsylvania (from whence I'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'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. 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 "see" what the picture is. 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're making (for a small company like ours) hundreds of units and even the large manufactures aren't making them like the Coca-Cola company spits out cans of soda. You're amortizing a lot more development costs into each unit. 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'd pay for your $8000 machine pretty quickly).
ChicagoBoy11 11y 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: http://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca.pdf http://faculty.chicagobooth.edu/john.cochrane/research/paper...
rdtsc 11y ago
Ultrasound machines of some sort is also pretty popular startup idea. I've heard at least of 3 people through personal connection who were building some sort of "ultrasound" 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.
z3t4 11y 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's hard to make something out of the image. I think it can be greatly improved by better software, so it get's closer to an MRI.
ck2 11y ago
They wanted $600 to ultrasound me when I had gallstones, it's a racket. Had to skip on that and just ate more fiber instead which thankfully solved that (pain was unbelievable).
- datenwolf 11y ago
  More fiber will not help you with gallstones at all (had to deal with them, too); it's fats you've to be carefull about. The problem is not fat in itself, but which other foods you combine it with. > They wanted $600 to ultrasound Well, they were asking that for the procedure, not for the device. The problem you had is, that you're probably living in a country with a laughable healthcare system. Guess what I did pay for my ultrasounds? Nothing, because it's covered by our mandatory insurance system. In fact most general practitioners have ultrasound machines (quite modern ones, too, I'd like to add).
  - ck2 11y ago
    would beg to disagree with you about fiber (you are right about the healthcare, if anything the price is only higher now that more people have insurance rather than price reform) after a few bad attacks over a couple years, it finally dawned on me to radically increase my fiber intake after reading up on it online no attacks for years now initially I had reduced my fat intake but now far less careful without any downsides cannot imagine anything worse than gallstone attacks, I literally thought I was dying the first time it ever happened
    - datenwolf 11y ago
      > cannot imagine anything worse than gallstone attacks, I literally thought I was dying the first time it ever happened I know that just too well. In case one ever happens to hit you again, I found out that a hot bath will give you instant relief. Don't ask me how it works exactly, I just found out, that it works.
raverbashing 11y ago
" computer that can run a MHz frequency transducer is easy and cheap these days, e.g. a raspberry pi’s GPIO pins can run that frequency." Yeah, but actually you need an ADC that runs at MHz frequencies and a frontend amplifier to capture the signal and put it into the ADC Definitely this falls into the "not expensive" category, but not in the "trivially cheap" one
- kelu124 11y ago
  Agreed, for a single element one there's a project on hackaday : https://hackaday.io/project/9281-murgen https://hackaday.io/project/9281-murgen =) 160$ cost for a single electronic board, not cheap, not so expensive..
daemin 11y 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 "portable" 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.
- boca 11y ago
  Startup name please?
  - daemin 11y ago
    A little company in Adelaide, Australia called Signostics (pronounced Sig - nostics). http://www.signostics.com.au/ http://www.signostics.com.au/
datenwolf 11y ago
Actually "Ultrasounds" are among the cheapest medical devices around. Practically "everybody" makes them and the market is oversaturated. The processing software is actually the least problematic thing; it'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's not an exaggeration: When I got invited to the group where I'm currently doing my PhD they were giving me a few datasets of raw, unprocessed Swept-Source OCT fringe data and said "have fun". A day later, using liberal application of NumPy I got pictures; another day and the quality was pretty good. "Ultrasounds" cost more than consumer goods, because, at the moment, they are not consumer goods. Compare this to the cost of "personal computers" in the 1980-ies. Just about as expensive, and "Ultrasounds" are kind of the medical imaging "PC" counterpart for general practitioners. So can "Ultrasounds" 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 >1kV against a highly complex and poorly matched impedance at bandwidths above 1MHz. That'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 >10$ per Unit and you need several of them. But that's only half the story: You also need to receive the reflected signal. Here'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'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. 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 "pro-sumer" (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/$. So you've solved all these essential problems. Now you have to make sure, that a mechanical failure doesn't expose the 1kV driving signal to the transducer to the patient. Here's the challenge: The transducers are separated by the thinnest possible layer of isolation material from the patient's skin, there's a pulsed >1kV amplitude AC signal right behind it, and between the probe and the patient you have conductor gel, which is essentially water jelly, that gives a nice acoustic impedance match, but also does a very good electrical match; we're talking body resistivity model in the two-digit ohms right now. Or in other words: A single manufacturing failure in your scanhead probe and you're going to electrocute the patient. Oh, you're thinking about just floating the whole transducer driver electronics. Smartass, that won't work, because you're operating with MHz AC here, so we're talking RF coupling, driving transducers with significant pulse power; you'll giving your "victim" RF burns, which are nasty. Come to think about it: 8000$ for a ultrasound imaging unit sounds pretty cheap.
deleted 11y ago
[deleted]
go13 11y 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?

195 points by grahar64 11y ago

tacon 11y 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 "black" 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 "black". Kind of freaked me out that my tendon was "dead" in the middle. The actual diagnosis was patellar tendinopathy, previously referred to as patellar tendinitis, or "jumper's knee". 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/visit, and the healing could take a year. On AliBaba, I checked how much a low end machine would cost to use at home. There were all sorts of machines available, and one manufacturer's rep latched onto me. I still get the occasional email checking if I'm ready to buy. I think these machines may require some doctor's approval, too, but I never went that far. But they sure don't cost anything like the prices in this article. In 2013, for quantity 1, IIRC, I was quoted $1100/each for this SUN-806F laptop plus sensor plus software unit: http://www.cnsunbright.com/china/english/newshow.asp?Cid=108&sid=149&PID=135 http://www.cnsunbright.com/china/english/newshow.asp?Cid=108... Maybe I'm missing something critical in this price difference? As the OP was explaining, you can almost build one yourself.

acqq 11y ago
So it was 3300 USD total for the solution? And the interesting detail, in the article that the author links there is this opinion from the doctor who uses the portable ultrasound device: http://www.kevinmd.com/blog/2014/05/pocket-ultrasound-machine.html http://www.kevinmd.com/blog/2014/05/pocket-ultrasound-machin... "Other doctors often ask me if I bill for my exams. I don’t, because billing and the detailed documentation and posturing that would be necessary to prove to an insurance company that an ultrasound was necessary would take more time than I have." The rest of the article is also insightful.
grahar64 11y ago
OP/author here, I also have patella tendinitis since I dislocated my patella when I was 17. This is the reason I started looking at ultrasounds, I figured that I could buy one for the $160 cost to get a scan from a doctor. I have looked around for a cheap ultrasound, but $1100 is far cheaper than I was able to find (I got to about $3k but looked like a dodgy dealer so didn't link to it). But 1k is still way more expensive than I think it should be. It should be a sensor you just plug into and iphone for a few hundred. I mean there is the http://www.thermal.com/thermal-cameras/ http://www.thermal.com/thermal-cameras/ thermal camera for only $250, why not ultrasound? Making a photo sensor must be thousands of times more complicated than ultrasounds sensors. I just want to know why I can't buy one cheaper than my massively more complex iphone :)
- sithadmin 11y ago
  >Making a photo sensor must be thousands of times more complicated than ultrasounds sensors. Cheaper thermal imaging sensors like that usually use a very, very low resolution sensor for picking up thermal data, then use interpolation to map the low-resolution data onto a high-resolution image provided by a higher-res conventional camera sensor. Obviously, this approach won't work with ultrasound tech, as there wouldn't be a secondary high-resolution data source.
  - grahar64 11y ago
    In the post there is a link to a paper where someone used a 40x40 array for 3d ultrasound imaging and there is a 64x array at 35MHz used for high resolution imaging of things like eyes. That is pretty low resolution for such interesting applications. Imagine the applications for a high resolution 3D ultrasound scanner combined with a high-resolution camera.
    - gene-h 11y ago
      It might be helpful to elaborate on what applications a 3d ultrasound scanner would have.
    - conceit 11y ago
bduhan 11y ago
A few months ago I almost ended up with a functional one from a local maternity ward for less than $100 on publicsurplus.com. I didn't realize the thing weighed =~ 400lbs until after bidding on it. Thankfully somebody else got the auction at the last minute.

n00b101 11y ago

To answer the question, it is because OP (Graham) hasn't created a startup to solve this problem. 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.

spydum 11y ago
Like a "post image to Facebook" or tweet this image button on the console? /s

esmi 11y 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.

ska 11y 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. This isn't the only thing going on, but it is naive at best to think of the price of these units as a parts list.

ghaff 11y ago
I agree with you but it can still be frustrating and there's a lot of entrenched interests involved. My story is that I broke my foot about 10 years ago (in the Grand Canyon no less). Long story short, when I eventually got the doctor, she told me that this kind of fracture always took a long time to heal and the literature suggested that electromagnetic stimulation had some benefit. Of course, the insurance company wouldn't pay until it was deemed a "problem fracture" in a few months (as my doctor thought it would be) but I did eventually get my $1000 stimulator at about 50% off. It had the most horrible interface one could imagine. If it slipped off the foot, it apparently simply shut down for that day's stimulation. In any case, my foot eventually healed. A few years later, a friend had a similar injury. I gave her my stimulator. Apparently the allowable stimulations had expired by then. She took it into a medical supply place and they were horrified by the idea that they might simply reset the device. I'm not a big pharma hater but this sort of story is why people get really mad.
- tn13 11y ago
  Those ridiculous pricing policies are necessary to recover the cost of regulatory compliance which is seriously huge component of anything medical in USA. As a side note, I know a company in India that manufactured a state of art blood test device. They tried to market it in USA and eventually gave up. Currently the company has tie up with Singapore hospitals which send blood to India for testing via flight and reports are mailed electronically automatically. There is a rig of blood testing machines in Powai-Mumbai which tests thousands of blood samples each day. This machine clearly can not be sold in USA (last time I checked was 6 years ago) because the cost of regulatory compliance is prohibitive. If the medical device manufacturers indeed made windfall profits I would love to invest in their stock but they don't seem to be doing as well as the hatred directed towards them.

dzhiurgis 11y ago

Philips got a device called Lumify, starts at $199 but requires monthly subscription to use.

grahar64 11y ago
Cheers, that is awesome. Here is a video https://www.youtube.com/watch?v=HRLHtnza2jM https://www.youtube.com/watch?v=HRLHtnza2jM It seems very limited for purchase, but would be cool to get my hands on one. I added it to the post :)

atourgates 11y ago

All medical technology is insanely expensive. My wife is an ophthalmologist in private practice, and we've spent far too much money on diagnostic equipment. 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" floppy drive. 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'd be spending something like $2,000 - $4,000 per room. With an Atom-powered mini-PC, I could get Windows hardware and a monitor setup in every room for about $300/room. I was hoping I'd be able to find some open-source visual acuity software, but it doesn'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've found is $400/room. Bringing my total cost to a (somewhat painful) ~$700/room. There is one piece of good Visual Acuity software in the Mac App Store[2] that we'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/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. What I'd love to see is industry associations working together to produce open source software that solves problems like this. Visual testing software isn't complex. A fairly reasonable investment could get something open source developed that would lower the cost of healthcare across the country, and worldwide. 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. 1. http://konanmedical.com/chart2020/ http://konanmedical.com/chart2020/ 2. http://www.kybervision.com/mac/visualacuity/ http://www.kybervision.com/mac/visualacuity/

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Aeolos 11y ago
Fancy that, my current project is to create a low-cost, high-quality optical coherency tomograph for private practitioners. I am planning to open-source the software and, depending on how things turn out over the next few months, possibly also the hardware designs. This device can immediately detect around 80% of the pathologies of the posterior eye segment. It's high time we made this part of first-line diagnostic exams.

asmithmd1 11y ago

There are Chinese made 3D machines for sale on EBay for less than $1000: http://www.ebay.com/itm/Portable-Digital-Ultrasound-Machine-Scanner-System-3-5-Mhz-Convex-Probe-Free-3D-/331342708500 http://www.ebay.com/itm/Portable-Digital-Ultrasound-Machine-...

grahar64 11y ago
I commented on the post that you can get a thermal imaging camera that plugs into your iPhone for $250 http://www.thermal.com/thermal-cameras/ http://www.thermal.com/thermal-cameras/ . So I think that any price above that for a unit that looks like it has a CRT monitor from the 90's is a bit expensive. I just want one as a toy and to experiment with, and think the cost is out of reach of that.
c-slice 11y ago
There is 0 chance that a US hospital or clinician will risk using an off-label ultrasound machine from china on a single patient. It's almost guaranteed to not be FDA/CE approved. That's how you get a malpractice suit.
- wongarsu 11y ago
  But the article also talks about the many other potential uses of ultrasound machines. For hobby use $1000 is still a bit steep, but for classroom use that might be doable.
- randyrand 11y ago
  For low income uninsured folks, it could find use. Especially in lower income countries. America holds its self to such a high medical bar that many simply can't afford healthcare. That is unreasonable.

revelation 11y ago

If you're patient, you might just find old machines (in some form of working order) show up on eBay and other marketplaces for old gear. There is a video series of a teardown/repair of an old baggage x-ray machine that was acquired this very way: https://www.youtube.com/watch?v=KPyE29ABmoA https://www.youtube.com/watch?v=KPyE29ABmoA In fact, looking through the other videos by the same guy, he seems to have a fair number of xray machines..

grahar64 11y ago
How is that legal? :)
- CamperBob2 11y ago
  Our (US) legal system doesn't work that way. If something isn't explicitly prohibited, it's permitted. This is a feature, not a bug. While it's not illegal to purchase and use an x-ray machine itself, it would be illegal to use one on human subjects without the proper training and licensing. (Unless, of course, you work for the TSA.)

m0llusk 11y ago

The current heavy hitter in the ultrasound industry is Zonare and the Zonare Technology page (http://www.zonare.com/technology/ http://www.zonare.com/technology/) 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. 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. 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.

c-slice 11y ago

Here are a few more reasons: 1) High touch sales process, slow sales cycles - ultrasounds take a long time to sell to hospitals/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't make sense to sell this way. 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. 3) Liability - complex medical devices that are used for critical diagnoses create big liability problems for the hospitals/clinicians. They have no incentive to choose the low-cost model sold by a startup. No one ever got sued for choosing GE/Philips/etc. 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't as effective, especially with a high touch/high cost sales process.

Gibbon1 11y ago
When I hear excuses about how some diagnostic test is expensive because the machines are expensive I think of airplanes and rental cars. So you say your ten year old ultrasound costs $50k? I can rent a $50k automobile for $150 a day, not for just ten minutes. And rent a space on a 120 million dollar airplane for a few hundred. And seriously, mom was an accountant. The capital cost of a $50,000 ultrasound machine is about $20/day. Meanwhile I have about $50,000 worth of test equipment sitting in my office. I'd never think of charging a customer a $2500 spectrum analyzer fee. Or a $400 oscilloscope diagnostic fee. Please.

madengr 11y ago

10 years ago when my wife was pregnant, a dianostic ultrasound cost $800, took 15 minutes, and the machine looked ancient. A 3D "fun scan" was $150, took 1 hour, and the machine was state of the art. Go figure.

Gibbon1 11y ago
Thing I harp on is that the medical industry is used to just charging whatever they can get away with. Since they have a generally naive and captive customer base, there is generally nothing to keep things real. My small experience with business is that when you have that situation you're set up to totally lose control of your costs. Because a lot of excess expenses are hidden in high margin products and services. Example, you make something for $5600 and sell it for $15,340. Could be that with a small amount of work you could produce the thing for $4200 ea. But because the margin is 'good' no one feels the need.
- HeyLaughingBoy 11y ago
  Actually my experience with the medical industry is that products get "value engineered" to oblivion. They are acutely aware of their margins and are constantly trying to improve them by reducing costs where it doesn't affect performance.
  - Gibbon1 11y ago
    In some parts of the device industry there is actual competition though.

vacri 11y ago

"Why is custom software so expensive to produce? Open-source components are free, so the final product should be, too!"

mathattack 11y ago

They could just as well be asking, "Why is Salesforce so expensive when the marginal cost of each additional user is negligible?" The answer is that the market price reflects a lot of other costs than just parts for adding an incremental user.

tlarkworthy 11y ago

Compared to an MRI machine it's very cheap

datenwolf 11y ago
The funny thing about this is, that technologically an MRI is much simpler compared to an ultrasonic imager: - Field coil - Gradient coils + coil driver - RF transceiver (essentially n SDR) The single most expensive part is the cryostat for the field coil. If there were high temperature superconductors that would retain their properties within strong magnetic fields you could build and operate MRI scanners much cheaper. A few years ago I did build a very crude and simplistic MRI scanner in my shack; it had a piss poor resolution of about 10mm³ took "ages" to scan a single plane and would dissipate huge amounts of heat in the (normal conducting) field coil; the gradient coils were driven by a regular HiFi audio amplifier. But it is definitely possible to build such a thing DIY and have it produce images (of poor quality).
- tlarkworthy 11y ago
  Wow that's really amazing. The super conductors are annoying in that they self distruct. I wonder if there is a cheap way to make one and gracefully shut it down when finished with it. I met one of the original engineers for ultrasound. The original design was 3d through mechanical scanning of the body

spyder 11y ago

http://www.dailymail.co.uk/health/article-2203114/Pregnant-wife-inspires-engineer-build-affordable-hand-held-baby-scanner-save-thousands-lives.html http://www.dailymail.co.uk/health/article-2203114/Pregnant-w... https://vimeo.com/49436607 https://vimeo.com/49436607 Looks like they use one or just a few transducer and move it manually to reduce the cost.

kelu124 11y ago
Indeed! That was a solution used 30 years back =)

awqrre 11y ago

Buy it from unregulated Chinese providers for personal use?

smoyer 11y ago

I designed an opthalmic ultrasound in the late '80s. The article describes "b-mode" 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. Central Pennsylvania (from whence I'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'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. 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 "see" what the picture is. 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're making (for a small company like ours) hundreds of units and even the large manufactures aren't making them like the Coca-Cola company spits out cans of soda. You're amortizing a lot more development costs into each unit. 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'd pay for your $8000 machine pretty quickly).

ChicagoBoy11 11y 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: http://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca.pdf http://faculty.chicagobooth.edu/john.cochrane/research/paper...

rdtsc 11y ago

Ultrasound machines of some sort is also pretty popular startup idea. I've heard at least of 3 people through personal connection who were building some sort of "ultrasound" 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.

z3t4 11y 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's hard to make something out of the image. I think it can be greatly improved by better software, so it get's closer to an MRI.

ck2 11y ago

They wanted $600 to ultrasound me when I had gallstones, it's a racket. Had to skip on that and just ate more fiber instead which thankfully solved that (pain was unbelievable).

datenwolf 11y ago
More fiber will not help you with gallstones at all (had to deal with them, too); it's fats you've to be carefull about. The problem is not fat in itself, but which other foods you combine it with. > They wanted $600 to ultrasound Well, they were asking that for the procedure, not for the device. The problem you had is, that you're probably living in a country with a laughable healthcare system. Guess what I did pay for my ultrasounds? Nothing, because it's covered by our mandatory insurance system. In fact most general practitioners have ultrasound machines (quite modern ones, too, I'd like to add).
- ck2 11y ago
  would beg to disagree with you about fiber (you are right about the healthcare, if anything the price is only higher now that more people have insurance rather than price reform) after a few bad attacks over a couple years, it finally dawned on me to radically increase my fiber intake after reading up on it online no attacks for years now initially I had reduced my fat intake but now far less careful without any downsides cannot imagine anything worse than gallstone attacks, I literally thought I was dying the first time it ever happened
  - datenwolf 11y ago
    > cannot imagine anything worse than gallstone attacks, I literally thought I was dying the first time it ever happened I know that just too well. In case one ever happens to hit you again, I found out that a hot bath will give you instant relief. Don't ask me how it works exactly, I just found out, that it works.

raverbashing 11y ago

" 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." 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 Definitely this falls into the "not expensive" category, but not in the "trivially cheap" one

kelu124 11y ago
Agreed, for a single element one there's a project on hackaday : https://hackaday.io/project/9281-murgen https://hackaday.io/project/9281-murgen =) 160$ cost for a single electronic board, not cheap, not so expensive..

daemin 11y 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 "portable" 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.

boca 11y ago
Startup name please?
- daemin 11y ago
  A little company in Adelaide, Australia called Signostics (pronounced Sig - nostics). http://www.signostics.com.au/ http://www.signostics.com.au/

datenwolf 11y ago

Actually "Ultrasounds" are among the cheapest medical devices around. Practically "everybody" makes them and the market is oversaturated. The processing software is actually the least problematic thing; it'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's not an exaggeration: When I got invited to the group where I'm currently doing my PhD they were giving me a few datasets of raw, unprocessed Swept-Source OCT fringe data and said "have fun". A day later, using liberal application of NumPy I got pictures; another day and the quality was pretty good. "Ultrasounds" cost more than consumer goods, because, at the moment, they are not consumer goods. Compare this to the cost of "personal computers" in the 1980-ies. Just about as expensive, and "Ultrasounds" are kind of the medical imaging "PC" counterpart for general practitioners. So can "Ultrasounds" 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 >1kV against a highly complex and poorly matched impedance at bandwidths above 1MHz. That'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 >10$ per Unit and you need several of them. But that's only half the story: You also need to receive the reflected signal. Here'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'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. 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 "pro-sumer" (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/$. So you've solved all these essential problems. Now you have to make sure, that a mechanical failure doesn't expose the 1kV driving signal to the transducer to the patient. Here's the challenge: The transducers are separated by the thinnest possible layer of isolation material from the patient's skin, there's a pulsed >1kV amplitude AC signal right behind it, and between the probe and the patient you have conductor gel, which is essentially water jelly, that gives a nice acoustic impedance match, but also does a very good electrical match; we're talking body resistivity model in the two-digit ohms right now. Or in other words: A single manufacturing failure in your scanhead probe and you're going to electrocute the patient. Oh, you're thinking about just floating the whole transducer driver electronics. Smartass, that won't work, because you're operating with MHz AC here, so we're talking RF coupling, driving transducers with significant pulse power; you'll giving your "victim" RF burns, which are nasty. Come to think about it: 8000$ for a ultrasound imaging unit sounds pretty cheap.

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go13 11y 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?