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Why Are Ultrasound Machines So Expensive?

322 points by grahar64 10y ago

ipunchghosts 10y ago
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/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.
- jostmey 10y ago
  Yeah, putting together the software to generate an image is not lot building a database or webservice. It requires engineering and science knowledge well outside the domain of computer science.
  - Declanomous 10y ago
    You can't program what you don't know. I actually chose biology over computer science because of problems like this[1]. Now, I don't think I have all the knowledge necessary to build an ultrasound myself, but at least I have the ability to read the literature and make sense of it, and I can understand the language radiologists and doctors use to describe an ultrasound. I don't think the programming would actually be that hard. It's basically sonar for people. There are tons of builds of devices that use time-of-flight to produce images. I think you could actually get something reasonable working pretty quickly if you had access to testing apparatus and a radiologist. I don't have the skills to build the ultrasound machine myself, but I'm not an EE. I don't think the programming is a huge barrier though. Quick edit: I would probably try emulating a system with physical lenses first. It seems like an easier problem. There was an article on Hackaday a while back about a guy who built a phased array radar in his garage, but it seems harder than the physical lens version: http://hackaday.com/2015/04/07/build-a-phased-array-radar-in-your-garage-that-sees-through-walls/ http://hackaday.com/2015/04/07/build-a-phased-array-radar-in... One quote from the article which I think is pretty relevant: "If you are willing to trade acquisition time for cost you could implement a much less expensive near-field array using switching techniques" And here's an article on a DIY Ultrasound development kit: https://hackaday.com/2016/04/12/a-developers-kit-for-medical-ultrasound/ https://hackaday.com/2016/04/12/a-developers-kit-for-medical... [1] I specifically wanted to do bioinformatics, but the field pays poorly, and also requires an advanced education.
    - ipunchghosts 10y ago
      I can assure you it's not sonar for people. The signal processing is way more complicated than traditional sonar. Sonar also has number roughly 10 channels. Ultrasound transducers have 10x more. The array is generally 2d and not planar either where sonar is generally a 1d planar array.
      - Declanomous 10y ago
        You can have a basic ultrasound with only on channel. The following patent is from 1985, and has a pretty good overview of the field at the time. It appears that most if not all untrasound transducers at the time were large single channel instruments. https://patents.google.com/patent/US4446395A https://patents.google.com/patent/US4446395A This patent, from 1989, indicates that most ultrasound transducers are either single element or linear arrays. It was the earliest patent I could find with a cursory look that had a 3 dimentional array. https://patents.google.com/patent/US5027820A/en https://patents.google.com/patent/US5027820A/en Regardless, even Wikipedia suggests that most of the arrays used for medical imaging use either a single element or a phased array: To generate a 2D-image, the ultrasonic beam is swept. A transducer may be swept mechanically by rotating or swinging. Or a 1D phased array transducer may be used to sweep the beam electronically. The received data is processed and used to construct the image. The image is then a 2D representation of the slice into the body. 3D images can be generated by acquiring a series of adjacent 2D images. Commonly a specialised probe that mechanically scans a conventional 2D-image transducer is used. However, since the mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2D phased array transducers that can sweep the beam in 3D have been developed. These can image faster and can even be used to make live 3D images of a beating heart. https://en.wikipedia.org/wiki/Medical_ultrasound#Sound_in_the_body https://en.wikipedia.org/wiki/Medical_ultrasound#Sound_in_th... Point being, I think you are wrong. I'm not an EE, so I can't speak towards signal processing, but I am a biologist by training, and I don't see a clear reason why sonar principles wouldn't work. We are basically a bag of salt water. Also, I am familiar enough with ultrasound to be sure that models with only a single transducer are very common. Hospitals and the like might be using the fancy-pants multi-dimensional arrays now, but the units we used to image things in college were definitely not multi-dimension. For one thing, they were older than the patent that demonstrated multi-dimensional arrays.
beambot 10y ago
The cmut or pmut transducer array, supporting hardware, onerous regulatory environment, and price elasticity in Western medicine.
vvanders 10y ago
Low unit test equipment is always expensive, see also: Oscilloscopes, Spec Analyzers, etc. You just don't see the volume that makes economies of scale kick in over your NRE(non-recurring engineering) costs.
- matt_wulfeck 10y ago
  I would hope that this type of hardware can be offset by the fact that these devices don't suffer obsolescence the same way other digital devices do, which need to be replaced because there's no longer 802.11b networks around etc.
  - karthikb 10y ago
    In many ways they're worse, especially specialized test equipment and protocol analyzers, because they're designed to evaluate the very thing that goes obsolete.
  - pjc50 10y ago
    Yes and no. At work we have a scope that will let you save traces onto a 1.44Mb floppy disk. Other people have test gear that runs DOS or Windows XP.
    - vvanders 10y ago
      There's also the issue of calibration and recertification. Some industries can skip it but I'm guessing it's a hard requirement in the medical field.
- sofaofthedamned 10y ago
  Good point. I used to work at a mobile startup that subsequently got acquired and burned - the run rate for a company of ~140 people was astronomical. Radio engineers are expensive and rare, scopes and even faraday cages are expensive, specialist software is expensive, handsets were a fortune when you had to buy hundreds of them. We got sold for (I think) about $330 million, then you look at social media startups that go for a couple of billion. Nobody wants to do stuff that changes the world for a reason.
xkcd-sucks 10y ago
TL;DR there isn't enough demand for specialty materials fab (PZT thin films for mHz range transducers) to benefit from economies of scale. Other stuff (software, controllers) is also expensive, but it's probably a fraction of the transducer cost so buyers tolerate it in order to get manufacturer support/service contracts
- ucaetano 10y ago
  One piece missing from the TL;DR: cost of compliance. Any medical device carries huge liabilities, and can easily bring a company down if it malfunctions. Probably the only other field that comes close to it is avionics.
  - briandear 10y ago
    Exactly this. Same for pharmaceuticals. This is why a "$5 pill" in Africa is $100 in the US. Medical device makers get sued practically every Tuesday. Anytime someone dies, the chain of liability is a very long one.
    - philipkglass 10y ago
      Eh, that "$5 in Africa" pill is often also "$10 in Canada or the EU." Oversight/certification costs money but that's only a small part of the explanation for why pharmaceuticals sometimes have far higher retail prices in the USA than in other developed countries.
      - logfromblammo 10y ago
        The pill is $5 in Africa, because it costs less than $5 to sell it in Africa. It costs $100 in the US because some Americans can afford to pay that much for one pill, and the rest can use manufacturers' coupons or collectively-bargained pricing agreements to pay less. Oversight, regulation, and certification is what prevents some applecart-upsetter from barging in to the market, charging $12/pill without any haggling. Instead, the incumbents can be tipped off by captured regulators that someone who won't play ball is on his way, so they can temporarily lower their price to $5/pill until the new jerk runs out of funding and dies. Then it's back to $100/pill. Heck, make it $1500/pill, pour encourager les autres.
Justin_K 10y ago
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.
- kem 10y ago
  One of the linked pages in the article illustrates the insanity surrounding health care and the FDA at the moment to me: https://www.quora.com/Why-is-the-Philips-Lumify-ultrasound-for-smartphone-not-available-for-consumers https://www.quora.com/Why-is-the-Philips-Lumify-ultrasound-f... One of the responses to the question is a respectful, reasonable post; the other responds with the typical protectionist FUD that permeates this area. The second asks about the costs of misdiagnosis by people using it inappropriately, but ignores the lost rewards of appropriate uses that are curtailed, and the costs of overpayment due to lack of competition to determine what level of training and payment is actually appropriate. The original article might be naive about some of the technological challenges associated with an ultrasound machine, but I think that's missing the point. When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting? Plenty of technically sophisticated open-source efforts exist, and they can't happen if there's arbitrary and unnecessary prohibitions on them happening. Maybe if the FDA said "hey, go to it" people would realize it's too hard, but maybe they wouldn't. We'll never know as long as there's unnecessary restrictions in the way.
  - DanBC 10y ago
    > When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting? Nothing is stopping you making, buying, operating a toy ultrasound, so long as you make clear that it's a toy and not to be used in human health.
compiler-guy 10y ago
I like free software as much as the next guy, but saying, "If there were free software for this project, the cost would come down." ignores that developing that software is expensive and someone needs to pay for it. 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.) Generally, the more broadly useful the software is, the more economic sense it makes to open the source. 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. So yeah, if it were free, it would cost less. OK then.
- guitarbill 10y ago
  > developing that software is expensive and someone needs to pay for it. or, you know, someone donates some of their time to write it. that's usually how OS works. think about how much research the person writing the article has done. if you could buy a $25 transducer off ebay, they could have put that time into writing the software.
  - pjmlp 10y ago
    > someone donates some of their time to write it. that's usually how OS works. Sure, those high school and university students building up their github portfolio for job interviews. The majority of serious open source projects are backed by hardware or consulting companies, and usually fade away when that support is no longer there.
    - guitarbill 10y ago
      Maybe, but for hobbyist projects? IDK, seems a bit condescending or at the very least defeatist. And who knows, the hobby project might transform into a company. Does that make it an instant "serious open source project"? Got to start somewhere.
      - 10y ago
riphay 10y ago
Previous discussion: https://news.ycombinator.com/item?id=11156288 https://news.ycombinator.com/item?id=11156288
russdill 10y ago
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.
sheyjaya 10y ago
High tech equipment are always very expensive.
temac 10y ago
> 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. This is ridiculous. Transmitting needs a good amount of energy for a high number of channels (several dozen, and quite often > 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. Reception is also not trivial at all, if you want a decent quality. You also sample at a rate > to the centre frequency. 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...
- titanomachy 10y ago
  > Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about I think it's pretty clear that he doesn't, but it's not like he's claiming to be an expert.
  - SAI_Peregrinus 10y ago
    An RPi costs about $30. A cheap FPGA Dev board with enough I/O capability to drive a transducer array costs about $300, and requires someone familiar enough with Verilog/VHDL/etc to actually program the thing. I'd guess he's off overall by at least an order of magnitude in any of his cost estimates, even if all the labor is free. I'm sure such a device can be made much more cheaply than existing solutions, but the author doesn't seem to have a realistic idea of the difficulty.
    - temac 10y ago
      Also the FPGA is not sufficient. You need something with both power capabilities and a decent freq capability, to drive pulses with some decent energy. On dozen of channels.
LeanderK 10y ago
What about emerging markets? If they are so expensive, they probably don'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. Beware: Just my thoughts, i really don't know much about the market and the money needed. I am probably wrong.
- prutschman 10y ago
  A company I co-founded, Shift Labs[1], is trying to do exactly that. The CEO, Dr. Beth Kolko, quit her academic post to found the company out of her frustration with low industry uptake of low cost medical devices emerging from academia. [1] http://www.shiftlabs.com/ http://www.shiftlabs.com/
edblarney 10y ago
Products are sold for prices the market will bear, which is only loosely related to the cost of making them. Or rather - if you sell a fixed number of items and could only reasonably justify a certain margin, then you don't want to make it cheaper. If barriers to entry are high - then you sit on your cash cow. This issue is very prominent in healthcare for both services and equipment. It's a very costly problem. Insurance companies want your bill to go up, not down, so they don't act as aggressively as they could to cut costs for small items. Hospitals - same. Because of the vast costs associated with regulation, overhead, marketing and near monopoly on many products, combined with massive 'price inelasticity' on part of the buyer (i.e. you'll pay 'whatever' to get fixed) - you get a problem. My parents both worked in pharma, it'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 'saving lives'. And it is serious business, you can't hack your way through most of it. 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 ... And you get unbelievably expensive healthcare. 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. Now - the first 'problem' in that scenario is that doctors are often paid to be good 'when things go wrong', and to get their yield way up (i.e. can't make mistakes) and both of those things are very expensive: you need to have 10 years of 'extra training' for the 1% of the time something weird happens. Fair enough - but I still think many of those things can be parameterized. Costs will not come down until their is an agent forcing it: the government, or preferably, another kind of provider. 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's something few understand. Their strategy is volume, and they have an ethos of sucking producer surpluses right out of the value chain. 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.
- DanBC 10y ago
  > 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. Imagine that your solution is a fraction of a percentage point worse than current treatment. Imagine there's 0.1% increase in harm. The English NHS sees 1m patients every 36 hours. In 2012 - 2013 there were 9 million ultrasounds. https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/KH12-release-2012-13.pdf https://www.england.nhs.uk/statistics/wp-content/uploads/sit... 0.1% of 9million is 9,000. I wouldn't want to tell those 9,000 people that their treatment was, even though they got harmed, good enough. And that 9,000 is just in England. If you want to save money on ultrasound spending you probably want to reduce the numbers of ultrasounds being taken. Healthy pregnant women with no problems only need one ultrasound, but in some places they're offered very many more. http://www.wsj.com/articles/pregnant-women-get-more-ultrasounds-without-clear-medical-need-1437141219 http://www.wsj.com/articles/pregnant-women-get-more-ultrasou... > In 2014, usage in the U.S. of the most common fetal-ultrasound procedures averaged 5.2 per delivery, up 92% from 2004, according to an analysis of data compiled for The Wall Street Journal by FAIR Health Inc., a nonprofit aggregator of insurance claims. Some women report getting scans at every doctor visit during pregnancy.
bkeroack 10y ago
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 find 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.
Animats 10y ago
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.
- angry_octet 10y ago
  You can already get '3D' ultrasound, which is many individual images stitched together. Doesn't work if the baby moves around alot. Expensive and not covered by health insurance. I don't think vet budgets are very large or favour high tech solutions but maybe you know otherwise.
  - agumonkey 10y ago
    I wonder how GPUs are impacting medical vision near the field. With a lot of post processing done on a 500$ card can't you get pretty far ?
  - Dove 10y ago
    I had a 3D ultrasound done at this place - http://www.firstviewultrasound.com http://www.firstviewultrasound.com - not long ago. I guess expensive means different things to different people, but I wound up with a CD full of a few dozen images and some movies for somewhere in the neighborhood of $100, which I thought it was a pretty good deal.
    - angry_octet 10y ago
      That is a good deal! A couple of years ago it was $500 but radiologists here are notoriously overpaid racketeers.
- ska 10y ago
  Typical consumer VR hardware isn't close to accurate enough for this. These sort of systems have been done though, as have 3D ultrasound via sweeping. Works quite well for some applications (e.g. Trans-esophageal)
ChuckMcM 10y ago
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. Arrays of sensors is still hard, driving them, reading them, and interpreting them. That particular engineering problem hasn't gotten that much easier.
Declanomous 10y ago
I'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. 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! Yes, electricity can kill you. Yes, improper medical advice can kill you. Yes, malfunctioning diagnostic equipment can lead to an incorrect diagnosis, which, yes, can kill you. Yes, medical regulations exist and protect us from harm. While a homebrew machine would not be able to compete with the latest and greatest, I'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. 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/EKG can be replicated pretty easily with an oscilloscope. It turns out, building an ECG is pretty trivial. It's not a 12-lead ECG, but it's also something I built out of parts I had on hand. I don't see why other medical technology should be any different. Yes, unregulated medical technology is dangerous, but the risk doesn'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.
- lawpoop 10y ago
  I think one of the problems of "but this is just a small engineering project" is precision, reliability, quality-- whatever you want to call it. There is interpretation that goes into reading an EKG, an xray, lab results. If there's any unreliability whatsoever, that will impact treatment and outcomes. If there's any unreliability in your EKG readout, that's can be the different between diagnosing a minor heart attack versus chest pain. The same goes for diagnosing a cancerous tumor from a benign one. There's already ambiguity and interpretation; if there's any imprecision in the measuring device, that's going to lead to bad outcomes-- both overtreatment and undertreatment.
grandalf 10y ago
There's a lot of nitpicking about the details going on in this thread, and it's very interesting to read. 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. 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. https://www.amazon.com/gp/product/B018XD6Z5O/ref=oh_aui_search_detailpage?ie=UTF8&psc=1 https://www.amazon.com/gp/product/B018XD6Z5O/ref=oh_aui_sear...
- amelius 10y ago
  > For example, I recently bought a 20MHz spectrum analyzer and oscilloscope with built-in tracking generator for $145. Nice. Does it work under Linux too?
  - grandalf 10y ago
    I'm not sure. I resorted to buying a copy of Windows 10 to use with certain software and utilities that seem primarily supported on Windows. The windows software seems to be under active development and I was able to skype chat with one of the engineers before I bought it to ask a few questions.
- pjc50 10y ago
  How's the UX on that? I kind of prefer having physical knobs and buttons, but I can imagine having better analysis and capture outweighs it. Maybe I should get one of those and a USB DJ controller for input.
  - grandalf 10y ago
    The UX is pretty good. The utilities seem to have originally been created for the Chinese speaking market but there are English language versions of the software that are very easy to use. Good idea about mapping some knobs to the UI. I've used it to measure harmonics when testing some low pass filters, and the readings match some other gear I own.
LurkerAbove 10y ago
I don'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'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.
rsingla 10y ago
It'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 See news here: http://www.mobihealthnews.com/content/clarius-mobile-health-gets-fda-clearance-app-based-wireless-ultrasound-scanners http://www.mobihealthnews.com/content/clarius-mobile-health-... See company website here: http://www.clarius.me/ http://www.clarius.me/
- Gibbon1 10y ago
  I think there are low end Chinese transducers that plug into a laptop that are $1500. That said the idea that an ultrasound machine is expensive is just laughable from a commercial/industrial cost perspective. Ok a mid range ultrasound machine costs $50,000. $50,000!!!! Oh the agony!!! Oh please, a taxi costs $30,000 and I can get a taxi ride downtown for $8. What's expensive is US medical pricing. Where they charge $700 for an ultrasound. When the machine itself has a capital cost of about $600/mo.
  - outworlder 10y ago
    You got lucky. My insurance got charged 6k for an abdominal ultrasound. Of which I'm on the hook for 2k still.
    - Gibbon1 10y ago
      Probably wouldn't be a good time for me to mention how much your dentists x-ray machine costs.
  - ihnorton 10y ago
    TeleMed [1] is slightly higher-end and has CE mark (IIRC in the $1-2k range for the uncleared/demo version). UltraSonix [2] used to be relatively reasonable option (IIRC under $10k), but they were bought by BK and prices may have increased. [1] http://www.pcultrasound.com/ http://www.pcultrasound.com/ [2] http://www.ultrasonix.com/ http://www.ultrasonix.com/
ska 10y ago
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. In medical devices this doesn'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.
mahyarm 10y ago
When cheap unregulated Chinese clones start coming out of ultrasounds like this one: http://intelametrix.com/FullSite/ http://intelametrix.com/FullSite/ thats when you know ultrasounds can be cheap.
pps43 10y ago
The reasons ultrasound machines are expensive are not technical, it's mostly low volume and high overhead to comply with all rules and regulations. 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). You don't need fast CPU for processing, just downconvert to audio range and then 80286 is fast enough. Source: wrote embedded software for one of those machines back in the day. 16 kB for everything, from keypad debouncing to GUI.
- temac 10y ago
  You are confusing several different thing under the vague notion of "ultrasound machines". Doppler mode is useful and cheap machines dedicated to that can and do exist. However even a basic machine able to do only a poor B-Mode needs at least vastly more processing power -- and vastly more channels.
  - pps43 10y ago
    Processing power is not a problem these days. Maybe if you feed all channels at ultrasound frequency to ADC and then try to do all processing in software. But you don't have to, it's oftentimes easier to have hardware (FPGA) pseudorandom signal generators and correlators to do the bulk of signal processing for you.
    - temac 10y ago
      It depends. An FPGA able to do that is a big one, quite expensive. Today, an even more so tomorrow, you can afford to do that kind of computations in a CPU and/or a GPU. Regardless of who is doing the beamforming, the TX and RX analog parts are intrinsically quite expensive with at least dozen of channels.
- shanacarp 10y ago
  It isn't low volume per say: lots of women get (medically unnecessary) 3d ultrasounds when pregnant to get "a nicer picture" at independent clinics. A lot of is regulatory, but not completely. - other issues include 1) expensive software integrations for EMR and billing reasons 2) that most machines have multiple wands to attach 3) That billing codes tend to support the use of expensive machines rather than cheap ones if a doctor wants to make money is probably related to billing codes/other non-embedded software
christophmccann 10y ago
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't just seen in medical ultrasound, but across healthcare. The regulatory and evidence burden is hard - but its not insurmountable and it certainly shouldn't stop change.
wolframarnold 10y ago
What I find missing from this discussion is the safety aspect of wholesale ultrasound. Yes, we've been told they'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's. That was before the evidence of birth defects from exposure to x-rays became so overwhelming that the practice finally stopped. See http://sarahbuckley.com/ultrasound-scans-cause-for-concern http://sarahbuckley.com/ultrasound-scans-cause-for-concern 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.
sytelus 10y ago
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 QA and certification 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'd to make device that is compliant of all these, it wouldn'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.
- knz 10y ago
  ADS-B transponders are a good example of this. They are mandated for most aircraft by 2020 and I've read/heard that the cost can be in the thousands.
- grecy 10y ago
  Same is true of software though. A company I worked for had a new website built (their big customer facing domain). It was just a Drupal theme, responsive, absolutely nothing fancy. An old friend of mine guessed $20k, maybe $30k tops if you were being crazy, and I thought even that was high. Back in our consulting days we probably would have quoted lower. They brought on a company for $1 mil, ended up 6 months late and $1.6 mil. Gotta love those project managers and "status update meetings" to burn the cash.
  - AtheistOfFail 10y ago
    The issue is support. Most companies won't buy unless you can guarantee a support contract for at least two years with new features being included in it. This is why software prices just skyrocket easily.
anon4this1 10y ago
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. There are also wireless ultrasound probes for around $800 USD - these could potentially come down in price too. The reason commercial ultrasound sound machines cost 50-500k is that hospital are paying for: - a brand name with reliability behind it - 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. - a support contract 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. 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'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/or becoming fashionable or falling out of fashion over time. 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. 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/ED docs/anaesthesiologists/ICU docs) to perform poor quality scans is a step back from having more specialised doctors performing fewer, high quality scans. 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/radiologists) and everyone, but we are not sure exactly where. 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/filipino sonographers for cost savings. 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.
LiesNStartupPR 10y ago
Having been involved in designing and building ultrasound systems for a couple of decades, I thought I'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. http://liesandstartuppr.blogspot.com/2016/12/why-are-medical-ultrasound-systems-so.html http://liesandstartuppr.blogspot.com/2016/12/why-are-medical... A quick summary - they're not expensive, in fact for what you get they are remarkably inexpensive. There's a huge amount or work that goes into them, and the author of the original piece simply doesn't even know enough about the subject to realise he doesn't know what he's talking about.
- bbcbasic 10y ago
  Upvoted. I love it when someone who really knows what they are talking about chimes in.
- balnaphone 10y ago
  Unfortunately, there is only a single line in the linked blog post regarding the economics of the situation : "made without the benefit of mass volumes (no millions of devices here)". The rest of the post is essentially meaningless, since it doesn't address the cost issue. The complexity in a sub-1k$ mobile phone is far greater than in a typical ultrasound imaging device that is currently in the field, but the economics of mass production enable massive reductions in price. In other words, you've provided some suggestions regarding the difficulty of the task, but have not in any way proven or convincingly demonstrated that sub-1k$ ultrasound imaging devices are an impossibility. From my POV, having also spent many years designing imaging systems and other devices to measure the human body (ultrasound, EEG, EKG, MRI), the biggest challenge to providing cheap consumer-grade tech here is the regulatory burden. If anyone wants to buy a sub-1k$ ultrasound imaging device, there are plenty of unapproved models on Alibaba that work just fine -- provided you're willing to test the device yourself for safety, to ensure it meets your own risk tolerances.
galtwho 10y ago
I met a guy in Chennai, India who sold Ultrasound machines some time back. On enquiry I learnt they don't sell any of the big brands cause they cost in millions and can't be afforded by most semi-urban or rural health facilities. 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.
cicero19 10y ago
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.
alphaoverlord 10y ago
I'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'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'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.
kozak 10y ago
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.
seesomesense 10y ago
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...
pogo 10y ago
Having started my career making military radars, I'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've ever seen for the seemingly excessive cost was from an episode of West Wing: https://youtu.be/7R9kH_HOUXM https://youtu.be/7R9kH_HOUXM 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.

322 points by grahar64 10y ago

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/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.

jostmey 10y ago
Yeah, putting together the software to generate an image is not lot building a database or webservice. It requires engineering and science knowledge well outside the domain of computer science.
- Declanomous 10y ago
  You can't program what you don't know. I actually chose biology over computer science because of problems like this[1]. Now, I don't think I have all the knowledge necessary to build an ultrasound myself, but at least I have the ability to read the literature and make sense of it, and I can understand the language radiologists and doctors use to describe an ultrasound. I don't think the programming would actually be that hard. It's basically sonar for people. There are tons of builds of devices that use time-of-flight to produce images. I think you could actually get something reasonable working pretty quickly if you had access to testing apparatus and a radiologist. I don't have the skills to build the ultrasound machine myself, but I'm not an EE. I don't think the programming is a huge barrier though. Quick edit: I would probably try emulating a system with physical lenses first. It seems like an easier problem. There was an article on Hackaday a while back about a guy who built a phased array radar in his garage, but it seems harder than the physical lens version: http://hackaday.com/2015/04/07/build-a-phased-array-radar-in-your-garage-that-sees-through-walls/ http://hackaday.com/2015/04/07/build-a-phased-array-radar-in... One quote from the article which I think is pretty relevant: "If you are willing to trade acquisition time for cost you could implement a much less expensive near-field array using switching techniques" And here's an article on a DIY Ultrasound development kit: https://hackaday.com/2016/04/12/a-developers-kit-for-medical-ultrasound/ https://hackaday.com/2016/04/12/a-developers-kit-for-medical... [1] I specifically wanted to do bioinformatics, but the field pays poorly, and also requires an advanced education.
  - ipunchghosts 10y ago
    I can assure you it's not sonar for people. The signal processing is way more complicated than traditional sonar. Sonar also has number roughly 10 channels. Ultrasound transducers have 10x more. The array is generally 2d and not planar either where sonar is generally a 1d planar array.
    - Declanomous 10y ago
      You can have a basic ultrasound with only on channel. The following patent is from 1985, and has a pretty good overview of the field at the time. It appears that most if not all untrasound transducers at the time were large single channel instruments. https://patents.google.com/patent/US4446395A https://patents.google.com/patent/US4446395A This patent, from 1989, indicates that most ultrasound transducers are either single element or linear arrays. It was the earliest patent I could find with a cursory look that had a 3 dimentional array. https://patents.google.com/patent/US5027820A/en https://patents.google.com/patent/US5027820A/en Regardless, even Wikipedia suggests that most of the arrays used for medical imaging use either a single element or a phased array: To generate a 2D-image, the ultrasonic beam is swept. A transducer may be swept mechanically by rotating or swinging. Or a 1D phased array transducer may be used to sweep the beam electronically. The received data is processed and used to construct the image. The image is then a 2D representation of the slice into the body. 3D images can be generated by acquiring a series of adjacent 2D images. Commonly a specialised probe that mechanically scans a conventional 2D-image transducer is used. However, since the mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2D phased array transducers that can sweep the beam in 3D have been developed. These can image faster and can even be used to make live 3D images of a beating heart. https://en.wikipedia.org/wiki/Medical_ultrasound#Sound_in_the_body https://en.wikipedia.org/wiki/Medical_ultrasound#Sound_in_th... Point being, I think you are wrong. I'm not an EE, so I can't speak towards signal processing, but I am a biologist by training, and I don't see a clear reason why sonar principles wouldn't work. We are basically a bag of salt water. Also, I am familiar enough with ultrasound to be sure that models with only a single transducer are very common. Hospitals and the like might be using the fancy-pants multi-dimensional arrays now, but the units we used to image things in college were definitely not multi-dimension. For one thing, they were older than the patent that demonstrated multi-dimensional arrays.

beambot 10y ago

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

vvanders 10y ago

Low unit test equipment is always expensive, see also: Oscilloscopes, Spec Analyzers, etc. You just don't see the volume that makes economies of scale kick in over your NRE(non-recurring engineering) costs.

matt_wulfeck 10y ago
I would hope that this type of hardware can be offset by the fact that these devices don't suffer obsolescence the same way other digital devices do, which need to be replaced because there's no longer 802.11b networks around etc.
- karthikb 10y ago
  In many ways they're worse, especially specialized test equipment and protocol analyzers, because they're designed to evaluate the very thing that goes obsolete.
- pjc50 10y ago
  Yes and no. At work we have a scope that will let you save traces onto a 1.44Mb floppy disk. Other people have test gear that runs DOS or Windows XP.
  - vvanders 10y ago
    There's also the issue of calibration and recertification. Some industries can skip it but I'm guessing it's a hard requirement in the medical field.
sofaofthedamned 10y ago
Good point. I used to work at a mobile startup that subsequently got acquired and burned - the run rate for a company of ~140 people was astronomical. Radio engineers are expensive and rare, scopes and even faraday cages are expensive, specialist software is expensive, handsets were a fortune when you had to buy hundreds of them. We got sold for (I think) about $330 million, then you look at social media startups that go for a couple of billion. Nobody wants to do stuff that changes the world for a reason.

xkcd-sucks 10y ago

TL;DR there isn't enough demand for specialty materials fab (PZT thin films for mHz range transducers) to benefit from economies of scale. Other stuff (software, controllers) is also expensive, but it's probably a fraction of the transducer cost so buyers tolerate it in order to get manufacturer support/service contracts

ucaetano 10y ago
One piece missing from the TL;DR: cost of compliance. Any medical device carries huge liabilities, and can easily bring a company down if it malfunctions. Probably the only other field that comes close to it is avionics.
- briandear 10y ago
  Exactly this. Same for pharmaceuticals. This is why a "$5 pill" in Africa is $100 in the US. Medical device makers get sued practically every Tuesday. Anytime someone dies, the chain of liability is a very long one.
  - philipkglass 10y ago
    Eh, that "$5 in Africa" pill is often also "$10 in Canada or the EU." Oversight/certification costs money but that's only a small part of the explanation for why pharmaceuticals sometimes have far higher retail prices in the USA than in other developed countries.
    - logfromblammo 10y ago
      The pill is $5 in Africa, because it costs less than $5 to sell it in Africa. It costs $100 in the US because some Americans can afford to pay that much for one pill, and the rest can use manufacturers' coupons or collectively-bargained pricing agreements to pay less. Oversight, regulation, and certification is what prevents some applecart-upsetter from barging in to the market, charging $12/pill without any haggling. Instead, the incumbents can be tipped off by captured regulators that someone who won't play ball is on his way, so they can temporarily lower their price to $5/pill until the new jerk runs out of funding and dies. Then it's back to $100/pill. Heck, make it $1500/pill, pour encourager les autres.

Justin_K 10y ago

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.

kem 10y ago
One of the linked pages in the article illustrates the insanity surrounding health care and the FDA at the moment to me: https://www.quora.com/Why-is-the-Philips-Lumify-ultrasound-for-smartphone-not-available-for-consumers https://www.quora.com/Why-is-the-Philips-Lumify-ultrasound-f... One of the responses to the question is a respectful, reasonable post; the other responds with the typical protectionist FUD that permeates this area. The second asks about the costs of misdiagnosis by people using it inappropriately, but ignores the lost rewards of appropriate uses that are curtailed, and the costs of overpayment due to lack of competition to determine what level of training and payment is actually appropriate. The original article might be naive about some of the technological challenges associated with an ultrasound machine, but I think that's missing the point. When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting? Plenty of technically sophisticated open-source efforts exist, and they can't happen if there's arbitrary and unnecessary prohibitions on them happening. Maybe if the FDA said "hey, go to it" people would realize it's too hard, but maybe they wouldn't. We'll never know as long as there's unnecessary restrictions in the way.
- DanBC 10y ago
  > When a response to "why can't anyone buy an ultrasound machine" is to disingenuously reply "because you have to have the FDA ensure that it's working correctly and people aren't running around killing each other with it," it puts huge constraints on innovation and growth in this area. I can go buy a crowbar and kill people with it, so why can't I buy an ultrasound and use it to study muscle movement, or for education, like the author of the posted article is noting? Nothing is stopping you making, buying, operating a toy ultrasound, so long as you make clear that it's a toy and not to be used in human health.

compiler-guy 10y ago

I like free software as much as the next guy, but saying, "If there were free software for this project, the cost would come down." ignores that developing that software is expensive and someone needs to pay for it. 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.) Generally, the more broadly useful the software is, the more economic sense it makes to open the source. 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. So yeah, if it were free, it would cost less. OK then.

guitarbill 10y ago
> developing that software is expensive and someone needs to pay for it. or, you know, someone donates some of their time to write it. that's usually how OS works. think about how much research the person writing the article has done. if you could buy a $25 transducer off ebay, they could have put that time into writing the software.
- pjmlp 10y ago
  > someone donates some of their time to write it. that's usually how OS works. Sure, those high school and university students building up their github portfolio for job interviews. The majority of serious open source projects are backed by hardware or consulting companies, and usually fade away when that support is no longer there.
  - guitarbill 10y ago
    Maybe, but for hobbyist projects? IDK, seems a bit condescending or at the very least defeatist. And who knows, the hobby project might transform into a company. Does that make it an instant "serious open source project"? Got to start somewhere.
    - 10y ago

riphay 10y ago

Previous discussion: https://news.ycombinator.com/item?id=11156288 https://news.ycombinator.com/item?id=11156288

russdill 10y ago

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.

sheyjaya 10y ago

High tech equipment are always very expensive.

temac 10y ago

> 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. This is ridiculous. Transmitting needs a good amount of energy for a high number of channels (several dozen, and quite often > 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. Reception is also not trivial at all, if you want a decent quality. You also sample at a rate > to the centre frequency. 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...

titanomachy 10y ago
> Citing a raspberry GPIO pin to do that shows that guy does not know what he is talking about I think it's pretty clear that he doesn't, but it's not like he's claiming to be an expert.
- SAI_Peregrinus 10y ago
  An RPi costs about $30. A cheap FPGA Dev board with enough I/O capability to drive a transducer array costs about $300, and requires someone familiar enough with Verilog/VHDL/etc to actually program the thing. I'd guess he's off overall by at least an order of magnitude in any of his cost estimates, even if all the labor is free. I'm sure such a device can be made much more cheaply than existing solutions, but the author doesn't seem to have a realistic idea of the difficulty.
  - temac 10y ago
    Also the FPGA is not sufficient. You need something with both power capabilities and a decent freq capability, to drive pulses with some decent energy. On dozen of channels.

LeanderK 10y ago

What about emerging markets? If they are so expensive, they probably don'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. Beware: Just my thoughts, i really don't know much about the market and the money needed. I am probably wrong.

prutschman 10y ago
A company I co-founded, Shift Labs[1], is trying to do exactly that. The CEO, Dr. Beth Kolko, quit her academic post to found the company out of her frustration with low industry uptake of low cost medical devices emerging from academia. [1] http://www.shiftlabs.com/ http://www.shiftlabs.com/

edblarney 10y ago

Products are sold for prices the market will bear, which is only loosely related to the cost of making them. Or rather - if you sell a fixed number of items and could only reasonably justify a certain margin, then you don't want to make it cheaper. If barriers to entry are high - then you sit on your cash cow. This issue is very prominent in healthcare for both services and equipment. It's a very costly problem. Insurance companies want your bill to go up, not down, so they don't act as aggressively as they could to cut costs for small items. Hospitals - same. Because of the vast costs associated with regulation, overhead, marketing and near monopoly on many products, combined with massive 'price inelasticity' on part of the buyer (i.e. you'll pay 'whatever' to get fixed) - you get a problem. My parents both worked in pharma, it'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 'saving lives'. And it is serious business, you can't hack your way through most of it. 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 ... And you get unbelievably expensive healthcare. 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. Now - the first 'problem' in that scenario is that doctors are often paid to be good 'when things go wrong', and to get their yield way up (i.e. can't make mistakes) and both of those things are very expensive: you need to have 10 years of 'extra training' for the 1% of the time something weird happens. Fair enough - but I still think many of those things can be parameterized. Costs will not come down until their is an agent forcing it: the government, or preferably, another kind of provider. 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's something few understand. Their strategy is volume, and they have an ethos of sucking producer surpluses right out of the value chain. 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.

DanBC 10y ago
> 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. Imagine that your solution is a fraction of a percentage point worse than current treatment. Imagine there's 0.1% increase in harm. The English NHS sees 1m patients every 36 hours. In 2012 - 2013 there were 9 million ultrasounds. https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/KH12-release-2012-13.pdf https://www.england.nhs.uk/statistics/wp-content/uploads/sit... 0.1% of 9million is 9,000. I wouldn't want to tell those 9,000 people that their treatment was, even though they got harmed, good enough. And that 9,000 is just in England. If you want to save money on ultrasound spending you probably want to reduce the numbers of ultrasounds being taken. Healthy pregnant women with no problems only need one ultrasound, but in some places they're offered very many more. http://www.wsj.com/articles/pregnant-women-get-more-ultrasounds-without-clear-medical-need-1437141219 http://www.wsj.com/articles/pregnant-women-get-more-ultrasou... > In 2014, usage in the U.S. of the most common fetal-ultrasound procedures averaged 5.2 per delivery, up 92% from 2004, according to an analysis of data compiled for The Wall Street Journal by FAIR Health Inc., a nonprofit aggregator of insurance claims. Some women report getting scans at every doctor visit during pregnancy.

bkeroack 10y ago

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 find 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.

Animats 10y ago

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.

angry_octet 10y ago
You can already get '3D' ultrasound, which is many individual images stitched together. Doesn't work if the baby moves around alot. Expensive and not covered by health insurance. I don't think vet budgets are very large or favour high tech solutions but maybe you know otherwise.
- agumonkey 10y ago
  I wonder how GPUs are impacting medical vision near the field. With a lot of post processing done on a 500$ card can't you get pretty far ?
- Dove 10y ago
  I had a 3D ultrasound done at this place - http://www.firstviewultrasound.com http://www.firstviewultrasound.com - not long ago. I guess expensive means different things to different people, but I wound up with a CD full of a few dozen images and some movies for somewhere in the neighborhood of $100, which I thought it was a pretty good deal.
  - angry_octet 10y ago
    That is a good deal! A couple of years ago it was $500 but radiologists here are notoriously overpaid racketeers.
ska 10y ago
Typical consumer VR hardware isn't close to accurate enough for this. These sort of systems have been done though, as have 3D ultrasound via sweeping. Works quite well for some applications (e.g. Trans-esophageal)

ChuckMcM 10y ago

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. Arrays of sensors is still hard, driving them, reading them, and interpreting them. That particular engineering problem hasn't gotten that much easier.

Declanomous 10y ago

I'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. 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! Yes, electricity can kill you. Yes, improper medical advice can kill you. Yes, malfunctioning diagnostic equipment can lead to an incorrect diagnosis, which, yes, can kill you. Yes, medical regulations exist and protect us from harm. While a homebrew machine would not be able to compete with the latest and greatest, I'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. 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/EKG can be replicated pretty easily with an oscilloscope. It turns out, building an ECG is pretty trivial. It's not a 12-lead ECG, but it's also something I built out of parts I had on hand. I don't see why other medical technology should be any different. Yes, unregulated medical technology is dangerous, but the risk doesn'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.

lawpoop 10y ago
I think one of the problems of "but this is just a small engineering project" is precision, reliability, quality-- whatever you want to call it. There is interpretation that goes into reading an EKG, an xray, lab results. If there's any unreliability whatsoever, that will impact treatment and outcomes. If there's any unreliability in your EKG readout, that's can be the different between diagnosing a minor heart attack versus chest pain. The same goes for diagnosing a cancerous tumor from a benign one. There's already ambiguity and interpretation; if there's any imprecision in the measuring device, that's going to lead to bad outcomes-- both overtreatment and undertreatment.

grandalf 10y ago

There's a lot of nitpicking about the details going on in this thread, and it's very interesting to read. 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. 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. https://www.amazon.com/gp/product/B018XD6Z5O/ref=oh_aui_search_detailpage?ie=UTF8&psc=1 https://www.amazon.com/gp/product/B018XD6Z5O/ref=oh_aui_sear...

amelius 10y ago
> For example, I recently bought a 20MHz spectrum analyzer and oscilloscope with built-in tracking generator for $145. Nice. Does it work under Linux too?
- grandalf 10y ago
  I'm not sure. I resorted to buying a copy of Windows 10 to use with certain software and utilities that seem primarily supported on Windows. The windows software seems to be under active development and I was able to skype chat with one of the engineers before I bought it to ask a few questions.
pjc50 10y ago
How's the UX on that? I kind of prefer having physical knobs and buttons, but I can imagine having better analysis and capture outweighs it. Maybe I should get one of those and a USB DJ controller for input.
- grandalf 10y ago
  The UX is pretty good. The utilities seem to have originally been created for the Chinese speaking market but there are English language versions of the software that are very easy to use. Good idea about mapping some knobs to the UI. I've used it to measure harmonics when testing some low pass filters, and the readings match some other gear I own.

LurkerAbove 10y ago

I don'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'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.

rsingla 10y ago

It'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 See news here: http://www.mobihealthnews.com/content/clarius-mobile-health-gets-fda-clearance-app-based-wireless-ultrasound-scanners http://www.mobihealthnews.com/content/clarius-mobile-health-... See company website here: http://www.clarius.me/ http://www.clarius.me/

Gibbon1 10y ago
I think there are low end Chinese transducers that plug into a laptop that are $1500. That said the idea that an ultrasound machine is expensive is just laughable from a commercial/industrial cost perspective. Ok a mid range ultrasound machine costs $50,000. $50,000!!!! Oh the agony!!! Oh please, a taxi costs $30,000 and I can get a taxi ride downtown for $8. What's expensive is US medical pricing. Where they charge $700 for an ultrasound. When the machine itself has a capital cost of about $600/mo.
- outworlder 10y ago
  You got lucky. My insurance got charged 6k for an abdominal ultrasound. Of which I'm on the hook for 2k still.
  - Gibbon1 10y ago
    Probably wouldn't be a good time for me to mention how much your dentists x-ray machine costs.
- ihnorton 10y ago
  TeleMed [1] is slightly higher-end and has CE mark (IIRC in the $1-2k range for the uncleared/demo version). UltraSonix [2] used to be relatively reasonable option (IIRC under $10k), but they were bought by BK and prices may have increased. [1] http://www.pcultrasound.com/ http://www.pcultrasound.com/ [2] http://www.ultrasonix.com/ http://www.ultrasonix.com/

ska 10y ago

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. In medical devices this doesn'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.

mahyarm 10y ago

When cheap unregulated Chinese clones start coming out of ultrasounds like this one: http://intelametrix.com/FullSite/ http://intelametrix.com/FullSite/ thats when you know ultrasounds can be cheap.

pps43 10y ago

The reasons ultrasound machines are expensive are not technical, it's mostly low volume and high overhead to comply with all rules and regulations. 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). You don't need fast CPU for processing, just downconvert to audio range and then 80286 is fast enough. Source: wrote embedded software for one of those machines back in the day. 16 kB for everything, from keypad debouncing to GUI.

temac 10y ago
You are confusing several different thing under the vague notion of "ultrasound machines". Doppler mode is useful and cheap machines dedicated to that can and do exist. However even a basic machine able to do only a poor B-Mode needs at least vastly more processing power -- and vastly more channels.
- pps43 10y ago
  Processing power is not a problem these days. Maybe if you feed all channels at ultrasound frequency to ADC and then try to do all processing in software. But you don't have to, it's oftentimes easier to have hardware (FPGA) pseudorandom signal generators and correlators to do the bulk of signal processing for you.
  - temac 10y ago
    It depends. An FPGA able to do that is a big one, quite expensive. Today, an even more so tomorrow, you can afford to do that kind of computations in a CPU and/or a GPU. Regardless of who is doing the beamforming, the TX and RX analog parts are intrinsically quite expensive with at least dozen of channels.
shanacarp 10y ago
It isn't low volume per say: lots of women get (medically unnecessary) 3d ultrasounds when pregnant to get "a nicer picture" at independent clinics. A lot of is regulatory, but not completely. - other issues include 1) expensive software integrations for EMR and billing reasons 2) that most machines have multiple wands to attach 3) That billing codes tend to support the use of expensive machines rather than cheap ones if a doctor wants to make money is probably related to billing codes/other non-embedded software

christophmccann 10y ago

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't just seen in medical ultrasound, but across healthcare. The regulatory and evidence burden is hard - but its not insurmountable and it certainly shouldn't stop change.

wolframarnold 10y ago

What I find missing from this discussion is the safety aspect of wholesale ultrasound. Yes, we've been told they'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's. That was before the evidence of birth defects from exposure to x-rays became so overwhelming that the practice finally stopped. See http://sarahbuckley.com/ultrasound-scans-cause-for-concern http://sarahbuckley.com/ultrasound-scans-cause-for-concern 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.

sytelus 10y ago

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 QA and certification 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'd to make device that is compliant of all these, it wouldn'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.

knz 10y ago
ADS-B transponders are a good example of this. They are mandated for most aircraft by 2020 and I've read/heard that the cost can be in the thousands.
grecy 10y ago
Same is true of software though. A company I worked for had a new website built (their big customer facing domain). It was just a Drupal theme, responsive, absolutely nothing fancy. An old friend of mine guessed $20k, maybe $30k tops if you were being crazy, and I thought even that was high. Back in our consulting days we probably would have quoted lower. They brought on a company for $1 mil, ended up 6 months late and $1.6 mil. Gotta love those project managers and "status update meetings" to burn the cash.
- AtheistOfFail 10y ago
  The issue is support. Most companies won't buy unless you can guarantee a support contract for at least two years with new features being included in it. This is why software prices just skyrocket easily.

anon4this1 10y ago

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. There are also wireless ultrasound probes for around $800 USD - these could potentially come down in price too. The reason commercial ultrasound sound machines cost 50-500k is that hospital are paying for: - a brand name with reliability behind it - 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. - a support contract 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. 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'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/or becoming fashionable or falling out of fashion over time. 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. 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/ED docs/anaesthesiologists/ICU docs) to perform poor quality scans is a step back from having more specialised doctors performing fewer, high quality scans. 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/radiologists) and everyone, but we are not sure exactly where. 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/filipino sonographers for cost savings. 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.

LiesNStartupPR 10y ago

Having been involved in designing and building ultrasound systems for a couple of decades, I thought I'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. http://liesandstartuppr.blogspot.com/2016/12/why-are-medical-ultrasound-systems-so.html http://liesandstartuppr.blogspot.com/2016/12/why-are-medical... A quick summary - they're not expensive, in fact for what you get they are remarkably inexpensive. There's a huge amount or work that goes into them, and the author of the original piece simply doesn't even know enough about the subject to realise he doesn't know what he's talking about.

bbcbasic 10y ago
Upvoted. I love it when someone who really knows what they are talking about chimes in.
balnaphone 10y ago
Unfortunately, there is only a single line in the linked blog post regarding the economics of the situation : "made without the benefit of mass volumes (no millions of devices here)". The rest of the post is essentially meaningless, since it doesn't address the cost issue. The complexity in a sub-1k$ mobile phone is far greater than in a typical ultrasound imaging device that is currently in the field, but the economics of mass production enable massive reductions in price. In other words, you've provided some suggestions regarding the difficulty of the task, but have not in any way proven or convincingly demonstrated that sub-1k$ ultrasound imaging devices are an impossibility. From my POV, having also spent many years designing imaging systems and other devices to measure the human body (ultrasound, EEG, EKG, MRI), the biggest challenge to providing cheap consumer-grade tech here is the regulatory burden. If anyone wants to buy a sub-1k$ ultrasound imaging device, there are plenty of unapproved models on Alibaba that work just fine -- provided you're willing to test the device yourself for safety, to ensure it meets your own risk tolerances.

galtwho 10y ago

I met a guy in Chennai, India who sold Ultrasound machines some time back. On enquiry I learnt they don't sell any of the big brands cause they cost in millions and can't be afforded by most semi-urban or rural health facilities. 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.

cicero19 10y ago

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.

alphaoverlord 10y ago

I'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'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'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.

kozak 10y ago

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.

seesomesense 10y ago

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...

pogo 10y ago

Having started my career making military radars, I'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've ever seen for the seemingly excessive cost was from an episode of West Wing: https://youtu.be/7R9kH_HOUXM https://youtu.be/7R9kH_HOUXM 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.