As ultrasound departments face rising exam volumes, increasingly complex patient populations, and heightened expectations around efficiency and staff well-being, the definition of a “best-in-class” system is evolving fast. For this Director’s Circle roundtable, ICE Magazine asked industry leaders to discuss what truly matters when evaluating ultrasound technology in 2026 — from image quality and AI assistance to ergonomics, serviceability and long-term value. Joining the conversation are:
- AdventHealth Ambulatory Imaging Center Clinical Manager of Ambulatory Imaging Services Lillian McGrier;
- Hartford Hospital/Bone & Joint Institute Ultrasound Manager Ashley Burke;
- Innovatus Imaging Vice President Sales and Marketing Matt Tomory; and
- University Hospitals Cleveland Medical Center Radiology Manager Jackie Knotek.
Q: When evaluating ultrasound systems today, what features or capabilities are truly “must-haves,” and how has that changed over the past few years?
MCGRIER: From a front‑line ultrasound tech perspective, “must‑have” features today are the ones that directly impact image quality, exam efficiency, patient comfort and tech ergonomics. Image quality that works on real patients, not just the ideal ones. We scan a lot more difficult patients than we used to: higher BMIs, sicker patients and limited mobility. Systems must deliver strong penetration, good contrast resolution and consistent performance across body types without forcing us to constantly fight the knobs. Advanced beamforming and AI assisted optimization are helpful when they’re reliable, but only if they don’t slow us down or override our control.
Time pressure has increased everywhere. A must-have system today must be able to boot quickly, have customizable presets that actually stay saved, minimize keystrokes and menu digging, and use auto measurements and auto labeling without sacrificing accuracy. One of the biggest changes is there seems to be more awareness of sonographer injuries, and newer systems should support safer scanning. They should be lightweight, have well-balanced transducers, flexible monitor arms and adjustable height consoles. They should also use touchscreens or simplified controls to reduce the strain of repetition. If a system causes shoulder or wrist pain by the end of a shift, it’s not acceptable anymore, no matter how good the images look. Society of Diagnostic Medical Sonography (SDMS) emphasizes the importance of these considerations.
Probes take a beating. Must-haves include clear imaging without drop-out and cables that hold up over time and clean easily without destroying a probe. Frontline staff feel it immediately when a system is unreliable. Crashes, freezing or long service delays are dealbreakers. A must-have system is one we can trust in a full schedule with no backup room available. Connectivity with PACS, reporting systems and EMRs is expected. We shouldn’t have to enter patient data, fix mislabeled studies or chase missing images. Anything that creates rework ends up falling back on the tech. There is a change from “image quality first” to “workflow efficiency and ergonomics.” Five to ten years ago, image quality alone could win the conversation. Today, how the system fits into our day matters just as much. With higher volumes and staffing challenges, ease of use and exam speed are no longer “nice to have,” they’re essential.
Automation and AI are now expected – but with caution. Automeasurements, view recognition, and AI assistance weren’t common before; now they’re expected baseline features. That said, frontline techs want tools that assist, not replace judgment. We trust automation when it’s consistent and transparent – and ignore it when it’s not. There’s more recognition of MSK injuries and burnout among techs. Systems are increasingly evaluated through the lens of “Can I scan on this for 8-10 hours a day, year after year?” That way of thinking is much stronger than it used to be. Older systems often required deep technical knowledge and heavy manual input. Today’s expectation is simplicity without sacrificing control.
The “must-have” ultrasound system today is one that: Produces reliable diagnostic images on real-world patients, helps us work faster without rushing patient care, protects our bodies and reduces fatigue, integrates cleanly into the clinical workflow, holds up under daily, high-volume use. If it doesn’t make a tech’s day easier, safer, or more efficient, it’s not truly a must-have anymore, no matter how advanced it looks on paper.
BURKE: Image quality has improved dramatically compared to even five years ago, and the top-performing systems are now much more comparable. Because of this, it’s increasingly important to evaluate the additional features and tools each system offers. For example, at our facility we perform a growing number of contrast-enhanced exams, and the quality varies significantly among vendors. When evaluating equipment, consider not only the exams you currently perform but also the services you may want to offer in the future. The technology available today can help expand your capabilities, elevate patient care and open the door to new clinical opportunities. In turn, this can support a more profitable department and enhance the care you provide to your community.
TOMORY: AI has certainly come a long way and is now standard on contemporary ultrasound systems. From exam flow to anatomy identification and analysis, it improves scan accuracy and speed while reducing the sonographer interactions with the controls. From a service perspective, I see access to diagnostics and service documentation as a must-have. Healthcare providers should have service options beyond the warranty period outside of the manufacturer if they choose to perform the service in-house or outsource to an independent service organization.
KNOTEK: The scan assistant is a great feature that we have on our GE machines. This aligns the tech to scan within the protocol parameters and in compliance with ACR guidelines. Another great tool is the use of contrast enhanced ultrasounds and elastography for specialty cases. From an interventional radiology perspective, contrast and fusion ultrasound is a highly used tool that has been very beneficial to our patients and performance of our intricate procedures.
Q: From your perspective, where do current ultrasound systems fall short? Are there workflow, performance or reliability challenges your team regularly encounters?
MCGRIER: Color doppler is an area where more optimizations can be made. The use of AI while helpful still needs some improvement. From the front-line ultrasound tech perspective, current ultrasound systems have improved in many ways, but there are still clear gaps between how the systems are designed and how they’re used in real clinical environments. Many systems are called “workflow optimized,” yet there are too many important functions buried in menus, presets that don’t always stay customized the way we set them, and switching between exam types, patients or probes can be clunky. When schedules are full and add ons are constant, even small inefficiencies add up. If a system requires extra steps to do basic things like labeling, measuring, or adjusting depth and gain, the tech absorbs that time pressure, not the system.
AI-assisted measurements, auto optimization and view recognition are improving, but they’re not always reliable. Auto measurements may be off in technically difficult patients. As a result, many techs end up doublechecking or redoing the work, which cancels the time savings. Automation helps when it’s consistent, but when it’s not, it becomes another thing we must manage while scanning.
Current systems still struggle at times with higher BMI patients, patients who can’t hold their breath or follow instructions, and limited mobility exams. Even high-end systems can lose penetration or contrast in these situations, forcing us to compensate with longer scan times, more patient repositioning or repeated scans. The expectation hasn’t changed, though, we’re still expected to deliver diagnostic images within the same time slot.
While ergonomics have improved, many systems still fall short for techs scanning 8-12 hours a day. Not all consoles adjust easily once positioned; monitors don’t always rotate or lower far enough for seated scanning, and some controls require repetitive wrist or shoulder movements. These issues contribute directly to fatigue and musculoskeletal strain. Over time, that affects not just comfort, but career longevity, something frontline techs are increasingly vocal about.
One of the biggest frustrations is software freezes or lag, unexpected boots, and slow bootup times at the start of the day or between patients. When a system goes down, it immediately impacts patient flow, delays exams and increases stress. In many departments, especially outpatient imaging, there’s little to no buffer or backup room, so reliability is just as important as image quality. Probes remain at a pain point due to cable failures, intermittent signal dropout, and lengthy turnaround times for replacements. Even a single probe issue can disrupt an entire day’s schedule.
The current ultrasound systems are powerful, but they’re still often designed with ideal workflows and ideal patients in mind. Front-line techs work in the opposite reality: high volume, staffing shortages, physically demanding exams and constant time pressure. From our perspective, the biggest opportunity for improvement isn’t adding more features; it’s making the existing ones work seamlessly, intuitively and sustainably for the people who use them all day, every day.
BURKE: We have identified several limitations in the vascular imaging performance of our current units. Visualizing slow flow is particularly difficult. Achieving consistent color flow and reliable spectral Doppler remains challenging even with optimized settings and support from our clinical applications teams. Additionally, penetration is insufficient for many patients with larger body habitus. While not all patients are ideal ultrasound candidates, there is a significant opportunity to improve image quality for this population.
TOMORY: Modern ultrasounds have come an exponentially long way in image quality, features, probe design and reliability – especially when compared to other imaging technologies. As mentioned previously, AI or as General Electric calls it, Intelligent Assist reduces sonographer repetitive motions which is critical for sonographer safety and career longevity. Probes are also getting lighter and more ergonomic which is a trend I would like to see continuing – again for sonographer health and safety.
KNOTEK: Our current ultrasound machines are highly functional and utilized for every need that we see in a Level 1 trauma facility. Workflow issues tend to fall under the volume within the department and triaging the ED, ICU and outpatient exams. This is when it is very important to have a strong team like the one at CMC to come together and do what is best for our patient care.
Q: Image quality has always been critical, but what other factors now carry equal or greater weight in purchasing decisions, such as service support, uptime, software upgrades or total cost of ownership?
MCGRIER: Service support and quality in timely responses, upgrades included in original cost and transparency in pricing all impact purchasing decisions. Workflow efficiency and ease in use should be considered. Systems need to help us work faster without forcing more advanced critical thinking on the tech’s part. Ergonomics and tech safety are major issues to be considered. We recommend techs look at console height and monitor adjustments, weight of probes, controls that decrease repetitive wrist movements and shoulder strain, and the ability to be seated and other scanning positions. Systems must be reliable under real-world, high-demand conditions. Other considerations should include solid integration into PACS, EHR, minimal data entry, and accurate data/demographic transfer. We now assume there will be AI and automations, but they need to be transparent and consistent. Patient variability such as BMI, mobility issues, patients who cannot hold their breath, and inconsistent penetration and contrast directly affect scan time and image quality. From an ultrasound tech’s perspective, does the system make their day easier, safer and efficient every time we use it? If the system doesn’t meaningfully improve the tech’s daily work, it’s no longer considered a strong purchase decision.
BURKE: We are fortunate to have an exceptional onsite biomedical team that is highly knowledgeable about our equipment and understands the importance of rapid turnaround times. Clinical application support is equally essential. We rely heavily on our clinical applications specialist to help us optimize our imaging and ensure we are consistently producing the highest quality images possible. This collaboration involves ongoing feedback and feedforward communication, which strengthens our ability to troubleshoot and improve performance. While I strive to be well versed in the functionality of our units so I can make necessary adjustments onsite, having accessible, responsive support remains critical. This level of support is not only necessary during installation of new systems but also whenever new challenges arise or updated software becomes available. Additionally, cost considerations cannot be overlooked. It is important that software upgrades and probe replacements are built into our contracts to ensure we remain fully covered and operational without unexpected financial burdens.
TOMORY: Contemporary ultrasound systems are all excellent in many areas and there is almost a parity when it comes to image quality. What is critical to look at are long-term features needed, service and probe repair support, and software support. Here we need to differentiate between software updates and upgrades. Updates are critical to system reliability, safety and cyber protection and need to be provided by the OEM regardless of warranty or contract status. Upgrades are added features that are optional but can be very expensive post sale so plan ahead on what you need now and down the road. Regarding service, HTM departments are becoming more involved in purchasing decisions due to their unique perspective. The availability of diagnostics, service manuals, “magic decoder rings” to access service software and probe repair support are all critical when evaluating the total cost of ownership. Probe repair capabilities are also critical. The OEMs continue to change the technology in their probes. One example is the new micro-connector and micro-coax that GE, Philips and Siemens started using. This technology will obsolete current probe repair service models. We at Innovatus have developed exclusive processes and instruments on these seemingly impossible probes to repair.
Q: How do you approach training and adoption when new ultrasound technology is introduced, and what role do vendors play in making that transition successful or unsuccessful?
MCGRIER: Hands-on, exam-based training is more effective than classroom overview or feature demonstration. If we can’t immediately translate what we’re seeing in training to a live patient schedule, adoption may be slower. It is an advantage to introduce new systems while full patient load volumes continue, in parallel with on-site vendor support. Techs learn best from each other. Having a super-user and/or subject matter expert in addition to vendor support helps by sharing practical tips that vendors may not have highlighted and help translate features into how it helps the tech finish the exam on time. Vendors who focus on everyday exams and do not showcase features, address difficult patients (high BMI, limited mobility, poor breath hold) and explain when NOT to use certain features, earn credibility with techs. Vendors should be available beyond the go-live date. They should return within weeks and months when issues arise. They should be expected to assist in optimizing presets after clinical use and continue providing ongoing education. Also critical is listening to tech feedback such as what is slowing them down and what features they are ignoring and why.
What vendors do that make an unsuccessful install are training each location as if it is the same as all other settings and companies, having limited support after go-live, excessive focus on features versus workflow impact, slow response to software or equipment issues, and restricting customization.
BURKE: With our high exam volumes and the varying schedules of our technologists, coordinating training can be challenging, but it is essential. We make sure every staff member receives adequate one-on-one time with the clinical applications specialist. On training days, we adjust room assignments to support technologists’ learning and ensure they have the time and space to focus. I also ask that my lead technologist be present for nearly every exam during applications training so they can continue developing as a subject matter expert and superuser. Additionally, I request that the vendor hold a brief huddle with the team at the start of the day, or during lunchtime, to provide background information, reinforce key updates, and answer any immediate questions. We ensure that there are multiple days of training and that we schedule follow-ups to cover any lingering questions or concerns.
TOMORY: A good applications specialist is critical to training when purchasing a new ultrasound platform or adding features to an existing one. My wife, a highly credentialed sonographer and ultrasound social media star (www.sonoeyesultrasound.com), was recently hired as a GE applications specialist and the training is very rigorous. Passion and extensive knowledge from the OEMs are critical to maximize the performance and usability of a new ultrasound system.
KNOTEK: Vendors and application specialists play a very important role for training. They allow for multiple days and make sure that all techs are properly trained to feel comfortable.
Q: Looking ahead, which trends in ultrasound technology are most likely to impact patient care and departmental efficiency in the next two to three years?
MCGRIER: The implementation of AI will impact patient care and departmental efficiency; however, it is important for new grads to still understand how to optimize without the use of AI, and to have an understanding of physics. As AI expands, the impact will depend on consistency and trust in the product. We need more accurate auto-measurements and auto-labeling on technically difficult patients. AI should adapt to high BMI, poor breath holds and limited mobility. The ability to override AI should be available. Exam times can expect to decrease under reliable AI. We should expect more consistent studies across all tech experience levels. New techs will still need to understand physics and image optimization. Small fixes in repetitive workflow pain points will help techs have a cleaner exam from start to finish with fewer steps for labeling, measurements and reporting. When the schedule is packed, saving 30-60 seconds per exam adds up. Less work means fewer delays, corrections and stress on the techs.
We should expect to see improvements with stronger penetration and contrast in high BMI patients, more stable color Doppler and spectral Doppler under difficult conditions, and better image quality when patients are unable to follow instructions. This means patients can expect fewer scans, shorter exam times and less patient repositioning and discomfort.
Over the next 2-3 years, the biggest impact will come from technology that aids techs in working faster without rushing patient care, performs consistently on patients, protects the tech and reduces burnout, is integrated seamlessly into daily workflow and supports clinical judgement, not replace it.
BURKE: With our high exam volumes and the varying schedules of our technologists, coordinating training can be challenging, but it is essential. We make sure every staff member receives adequate one-on-one time with the clinical applications specialist. On training days, we adjust room assignments to support technologists’ learning and ensure they have the time and space to focus. I also ask that my lead technologist be present for nearly every exam during applications training so they can continue developing as a subject matter expert and superuser. Additionally, I request that the vendor hold a brief huddle with the team at the start of the day, or during lunchtime, to provide background information, reinforce key updates, and answer any immediate questions. We ensure that there are multiple days of training and that we schedule follow-ups to cover any lingering questions or concerns.
TOMORY: AI will continue to evolve to the point where a system will perform sweeps through anatomy and then dissect for diagnoses and analysis. This does not mean a highly trained and credentialed/registered sonographer will be replaced by the system, but it will assist to improve exam accuracy, speed and sonographer safety.
Q: If you could offer one piece of advice to peers evaluating or upgrading ultrasound equipment in 2026, what would it be?
MCGRIER: Be open to doing a lot of research and making decisions based on the consistency of the vendors. Having a clinical ultrasound team member and radiologist involved in the decision can help with cost savings in purchasing the technology that will be used. I recommend evaluating the system under real clinical conditions and listening to the technologists who will use it every day. Decisions should be made based on how the system works in the hands of the ultrasound techs and the physicians reading the exams. If you trust the ultrasound tech’s feedback and evaluate the system under real conditions, your decision should hold up long after installing.
BURKE: Be critical. When trialing new units, ask detailed questions, test them on challenging patients, and know the image quality standards you expect. Stay open to vendors you haven’t worked with before, you may even find value in having multiple manufacturers represented within your department. Even if you decide not to move forward with a purchase, your honest, constructive feedback helps advance the field and pushes vendors to continue improving. Remember, they want your business, make them earn it.
TOMORY: Plan on supporting the new system for an average of seven years – what do you need to support the system and probes after the warranty expires? Probe repair for high technology probes and service options for the platform are critical.
KNOTEK: It is important to think outside of the box with new technology and future state for the department. Ultrasound is always advancing and although you may not see a need for the technology presented at the time, it is a great opportunity to advance not only the skills of the techs but also broaden the department and increase patient experience.
This month’s article was sponsored by Innovatus Imaging. For more information on this company, visit innovatusimaging.com.
1-844-687-5100 | customercare@innovatusimaging.com
