Faced with the question as to whether rumours are true that the Siemens ultrasound business is floundering, the company’s CEO of Clinical Products answered frankly: ‘That depends. It is true that in the past years our ultrasound products did not meet expectations. Therefore we are currently working twice as hard to regain lost ground,’ Norbert Gaus said. ‘After some poor decisions in the past we’ve taken a number of corrective measures and are now starting to reap the rewards of our endeavours. As far as our products are concerned – the tried and true ones as well as the innovations – we have become clearly more competitive and indeed technologies such as the S2000 Automatic Breast Volume Scanner (ABVS) are unique in the market.’
What exactly did the firm change?
‘We put a lot of effort in fine-tuning the products, above all in three pillars of ultrasound technology: stability, reliability and image quality. The first thing the customers see in an ultrasound system is the image. Sales people often do side-by-side demonstrations, with equipment by different vendors. In these demos image quality is frequently the one and only opportunity to convince the potential customer. Reliability and stability come in later. But if these three pillars are not balanced out in a system, it’s going to be difficult to prevail in the market. We didn’t set the right priorities in the past. Now we do!
Is ultrasound limited in terms of image quality?
‘Yes and no. Ultrasound is and will remain a very special imaging modality that needs quite a bit of abstraction. Whilst the ABVS already surmounts ultrasound’s inherent need for abstraction by offering homogenous 3-D volume images, there are many clinical issues that can only be answered sonographically. Ultrasound does not use radiation and the systems are more accessible and flexible in their range of use than large equipment. Obviously there are physical limitations but these limitations only apply to the point where other physical phenomena come in.’
What is the significance of ultrasound today?
‘In addition to X-ray, ultrasound is still always and everywhere the basic or initial modality. There are customer groups who above all buy these two modalities, particularly office-based physicians but also customers from emerging markets where people do not have equal access to medical technology. However, the governments of those countries are heavily investing in their healthcare systems and, for example, want to improve the quality of medical services in rural areas.
‘In this situation ultrasound is always the first choice, other modalities follow. In addition, the range of ultrasound applications will expand. There is currently no imaging modality that offers greater clinical versatility than ultrasound. I dare say that, in terms of technology, there is no other modality that has the potential to embark on entirely new paths.
‘Initially,’ he explained, ‘there are workflow innovations such as automation processes. With every modality the cost pressure is enormous thus productivity must be increased by efficiency gains in order for the doctor’s office or hospital to be able to stay competitive. Secondly, innovations in terms of image quality will be realised, triggered by the matrix technology of the transducers, for example. These innovations are crucial as improved penetration is required to examine the increasing number of obese patients.
‘I personally expect quite a lot from elastography. This technique started off as merely mechanical compression. However, in the meantime it offers automatic procedures that are not only qualitative but rather the transducer generates special ultrasound impulses and shear wave speed is measured, which allows evaluation of tissue stiffness.’
Surely elastography is a particularly competitive area?
‘There are a number of research issues, such as elastography, in which Siemens and other vendors are active – a fact that indicates the potential of this technology. If you look at the history of ultrasound from anatomy to Doppler you recognise that tissue characteristics seem to be the next big step in the evolution. This starts with the detection of lesions and moves on to temperature measurements in order to control and guide the interventions. The next five years will show where these developments are heading.’
Is Siemens also working on HIFU?
‘High-intensity focused ultrasound therapy definitely has potential– and indeed we do research in this area. We’re interested in HIFU compared to MRI-guided interventions and follow the course of the developments to decide when and where we will invest our resources.
‘Another important issue with regard to interventions is image fusion of ultrasound, MRI and CT. I expect ultrasound to prevail particularly with regard to heart valve replacement, be it as TEE transducer or image-guided catheter intervention. In the future this procedure will most likely be performed with a 3-D enabled intracardiac echocardiography catheter.’
How do you perceive Asian competition?
‘Level-headed and realistic -- I assume that many Asian companies will enter the global market in the future, and not just in medical imaging. However, there will also be shake-downs and, in the end, there’ll be one or two new competitors that are here to stay.
‘Quite honestly, there are so many new competitors from all over the world – China, Japan, Korea, the Netherlands or the US – we have to keep an eye on all of them. For us it’s important to remain the innovation leader and to cover both the high and low end of the range. That is what makes all our modalities unique. We always manage to integrate innovations from the premium products into the budget products.’
"Pioneering the future of ultrasound", Siemens Lunch Symposium, Monday, August 29, 12:30-13:30, Hall F1
Elastography – Tissue strain analytics
Tissue strain analytics, more commonly known as elastography, adds an additional, independent parameter to the existing morphological diagnostic process. By interrogating and measuring the mechanical strain properties of tissue, the technology can visualise the stiffness of tissue, a finding often correlated with pathology.
Unlike earlier manual elastography compression techniques, the latest advance in elastography is Acoustic Radiation Force Imaging (ARFI), a technology that uses sound waves to compress tissue.
Siemens’ implementation of ARFI, Virtual Touch tissue analytics, delivers both a qualitative and a quantitative assessment of tissue. Virtual Touch Tissue Imaging creates a relative stiffness map (elastogram) for any region of interest; Virtual Touch Tissue Quantification produces a numerical value of shear wave speed related to tissue stiffness at a precise anatomical location. The result is a reliable classification of tissue stiffness allowing clinicians to assess the state and development of disease, e.g. identify early stages of liver diseases causing cirrhosis.
Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification are available on the ACUSON S2000 ultrasound system.
Images courtsey of Dr. Dirk-Andre Clevert Interdisciplinary Ultrasound Centre, University Hospital Munich, Grosshadern Campus