Director’s Circle: Ultrasound

Ultrasound technology continues to redefine the standards of imaging with its non-invasive nature, diagnostic versatility and constant advancements. In this exclusive March 2025 Director’s Circle roundtable, industry leaders and experts delve into the critical aspects of ultrasound devices shaping modern medicine. From evaluating image quality and advanced functionality to the nuances of equipment procurement and staff training, this discussion highlights the strategies, challenges and exciting innovations that are influencing the field. Whether you’re navigating procurement decisions or considering the latest trends, this dialogue offers insights for healthcare professionals invested in ultrasound excellence.

Participants in the March 2025 Director’s Circle roundtable on ultrasound are:

• AdventHealth West Florida Division Director of Radiology Rebecca Kitta
• Banner Imaging Associate Manager-Medical Imaging Kalen Terry
• Corewell Health Senior Imaging Specialist-Ultrasound Danielle Tiefenthal

Q: What are the most critical features or specifications you look for in an ultrasound machine?

Kitta: When considering ultrasound units, I tend to prioritize features and specifications that align with clinical needs, operational efficiency, and long-term investment value. The most critical considerations I consider include imaging quality, portability and ergonomics, artificial intelligence (AI) and automation, interoperability and connectivity, specialty-specific customizations, durability and maintenance, and last but certainly not least cost efficiency

Terry: The most critical features or specifications that I am looking for in an ultrasound machine are image quality, transducer types, doppler capabilities, high-definition display, user friendliness, and advanced software options such as liver packages to include Elastography, UDFF/UGAP, and advanced OB software for our sites in Colorado. 

Tiefenthal: Ultimately, we’re looking for image quality, and by that we’re looking at resolution with increased depth/penetration. We’re looking for quality of the grayscale image when Color Doppler is on, how crisp and sensitive is the Spectral Doppler. Aside from the quality of the basic ultrasound imaging functions, I’m looking for the advanced functions like SMI/microvascular flow, how user friendly is Elastography and 3D imaging? What is the wide view, convex, and dual screen imaging like? Does dual screen imaging reduce your FOV more than you’d like or does it keep your whole FOV. These things matter to every exam we perform, it’s important to have a solid understanding of what the machine can do. It’s also important to understand the probe selection, and which functions are compatible with those probes as not all technology is available on every probe. 

Q: How many ultrasound systems are currently in use in your department, and what is their average age?

Kitta: Today we have approximately 56 ultrasound systems installed. The average age is 7 years old. 

Terry: We currently have 53 ultrasound units across Banner Imaging, average age 8 years. 

Tiefenthal: Corewell Health West region has about 60 ultrasound machines within imaging across several locations. In 2024, we were fortunate to do a large install of 42 new machines, and 8 upgraded machines so I have a very young fleet to manage, and it has been an incredible experience. Prior to this install the average age of our machines was about 10 years old, which is a little higher than our typical life cycle replacement age.

Q: Are there any specific challenges you face with your current ultrasound equipment?

Kitta: Today our challenges are centered around having different system vendors or models in most ultrasound departments. This presents workflow challenges. Additionally, with new techs entering the workforce, this presents issues with training and leveraging technology available on each system.

Terry: Currently, our biggest challenge is that we have a few different platforms, each with their own unique level of technology. While our newer units deliver high-quality images with ease, our older units are very dependent on the technologist to utilize their physics expertise and knobology skills to obtain a diagnostic image. Older units also require more frequent repairs over time. 

Tiefenthal: Currently, with a very young fleet of equipment, we’re fortunate to have very few issues. We do have some units that are older that have issues with dropping presets, diminished image quality, and things that we typically see with aging technology – but we work through it. We have a great team of inhouse service engineers who partner with vendor service teams. I personally partner with applications support and we work together to optimize units the best we can.

Q: What factors are most important when selecting a new ultrasound system?

Kitta: Image quality, AI, technologist and patient safety, vendor training and support, and cost are the most important considerations to me when purchasing a new ultrasound system.

Terry: When I am evaluating an ultrasound machine, I am looking for image quality, user friendliness, reliability, and cost. Ultrasound machines are becoming more intuitive, which increases efficiency, and in a fast-paced clinical setting, that is imperative. It is crucial to have a machine and technologist that can perform high quality ultrasounds to provide comprehensive diagnostic information. I also need a machine that is durable and reliable. It needs to be able to withstand frequent use and provide consistent performance overtime, with minimal down time. I also must consider affordability. The cost of maintenance, transducers and software upgrades all need to be considered to ensure the long-term sustainability of the equipment. These factors together help ensure that the ultrasound machine will meet clinical needs, improve patient outcomes and maintain operational efficiency.

Tiefenthal: It’s important to look at all aspects of the purchase. Of course, imaging quality is at the top of the list, that’s why we’re all here, but vendor applications support, and service support should be part of the discussion as well. How local is apps support? Are they responsive when there are questions? The machine goes down or is having issues, how long until parts can arrive? Do they have loaner probes if you’re in a pinch? These are all things that matter to your organization’s operations outside of being able to provide excellent image quality. 

I recommend working with vendors to set up equipment demos, get hands on, scan patients and/or volunteers, push buttons and really be sure the equipment meets the needs of the department. Not only does this allow you to manipulate the presets and test image quality across many types of patients, but it also allows you to meet and work with the applications and sometimes service teams. You really get to work with the whole team and get an idea of the support that comes with purchasing.

Q: How do you ensure that radiologists and sonographers are adequately trained on new ultrasound systems?

Kitta: We work closely with our vendors to assure that each unit is installed appropriately. We then have the vendor’s ultrasound specialist on-site for training. We have lead technologists who help to assure each person attends training and coordinates additional training as needed.

Terry: To ensure our staff is adequately trained on new systems, we have vendor-supported onsite training with clinical applications specialists. We block our schedules to allow enough time for the technologists to learn the new machine, while working with the vendor to fine tune settings, and to adjust and refine technique. The apps specialist stays on site with the technologists as they scan patients to address any questions the tech may have or to make real-time adjustments if needed. We have had great apps specialists over the years that are very hands on, thorough and helpful! Once our technologist(s) are proficient in using the new machine, we offer peer-to-peer training to additional technologists. Our vendors have been great about checking in with us regarding how the system is performing and the image quality. They prioritize our feedback and will return to adjust settings when needed. Our radiologists are involved in our on-site demos prior to purchasing machines. I work with our CMO, Dr. Khan, to communicate any information or changes that need to be sent to our radiologist groups.

Tiefenthal: The partnership you build with your vendor can be incredibly beneficial in this area. If you’re purchasing new equipment, I would recommend outlining a detailed installation plan – provide your vendor with a list of key functions, exams, etc. to help the apps team know how to best support your team’s needs. Schedule adequate time with applications and give the department leaders enough time to prepare their patient and staff schedule. Of course, that doesn’t cover the sonographers who enter the organization after initial installation, so we find it helpful to keep a library of tip sheets available to help guide our teams on functions of the machine. We also have an onboarding plan that allows for time to become familiar with the machines. In the event we have radiologist in need of equipment training, we either partner with our vendor or have them work with an experienced sonographer to get familiar with the machine. Physicians also have access to the tip sheets if they find them helpful.

Q: What trends or developments in ultrasound technology are most exciting or relevant to your department?

Kitta: For me, the most exciting trends in ultrasound today are furthering the development of AI including deep learning imaging, high-resolution imaging that utilize microbubble contrast enhancement, and multi-modality integration for enhanced diagnostics specifically in the interventional radiology and oncology spaces. These advancements are pushing ultrasound beyond traditional diagnostic roles and into therapeutics and other areas, making it more accessible, versatile and impactful.

Terry: Being that we have so many systems across a large geographical area, I am very intrigued by fleet management software. When a change is needed to be implemented, I currently travel to the sites myself to adjust protocols or settings, or must schedule with an application specialist, which can take weeks. I recently learned about GE’s software Verisound, which would allow me to make configurations remotely in minutes. I think this would allow us to be more efficient as a department, but also provide our patients consistent ultrasounds with standardized protocols, regardless of which Banner Imaging they receive their care from. 

Tiefenthal: We’re currently working to implement the use of Liver Fat Quantification technology (ATI/UGAP) into our exams where appropriate. Ultrasound is constantly evolving; we work hard to stay informed as to what technology is available or possibly coming to market and then assess if it is something that would benefit our exam quality. Not all technology will serve the department in the same way so it’s important to evaluate the benefit of each function as they often come at a cost. Purchasing a new technology that won’t be used, doesn’t offer significant quality improvement, or isn’t billable may have negative impacts on future replacement purchases.

Q: What else should ICE Magazine readers know about ultrasound devices?

Kitta: Ultrasound is being used more broadly each year. Assuring that ultrasound systems meet quality standards, and the staff is trained appropriately on the technology the system has is extremely important. 

Terry: While ultrasound technology is improving and becoming more intuitive and user friendly, ultrasound is still a very tech-dependent modality. Modern ultrasound systems determine the quality and clarity of the images, but the technologist must utilize their expertise to obtain the best possible image to assist the radiologist in providing a diagnostic report. 

Tiefenthal: Ultrasound devices continue to evolve, and they are not one size fits all. It is important to do your homework, demo, ask questions, and make sure the units you’re looking at truly meet the needs of the department. With POCUS becoming more popular, we’re seeing great advancement in handheld and portable devices which is exciting. It can be easy to lose track of ultrasound because a new unit doesn’t require facility changes like a new CT or MRI, but the advancement in ultrasound technology continues to be fast-paced and updating ultrasound equipment will continue to be a need in many service lines. Ultrasound can evaluate more and more areas of the body that it didn’t in the past because of the new technology, making ultrasound competitive in ways it historically wasn’t. For organizations to be able to offer improved and specialized services, they need to be able to replace aging technology more often. This may present barriers but, ultimately, it’s great to continuously see the demand for the modality as a whole continue to grow.