A Handy Solution
By Keith Loria
Radiology Today
Vol. 25 No. 4 P. 22

Handheld ultrasound continues to trend in 2024.

Handheld ultrasound is more common than ever, and that trend is expected to continue in 2024, particularly for use in remote areas, in emergency care, and even for first responders. In response to this trend, a number of companies, including traditional ultrasound manufacturers and startups, launched new handheld ultrasound over the past year.

“From a fiscal perspective, sites that already have cart-based or compact ultrasound systems may be looking to complement their ultrasound imaging with a handheld unit, which can more easily be brought to the patient, particularly if they are not in a traditional health care setting,” says David Hoggle, vice president of ultrasound in the Americas for Konica Minolta Healthcare. “We have seen broader acceptance of ultrasound in musculoskeletal/orthopedic, anesthesiology, and critical care recently, although this is not necessarily a trend just in handheld ultrasound.”

There is also rising interest in how AI can further help with clinical workflow, consistency of imaging, and providing more quantitative measurements in ultrasound imaging.

John Martin, MD, CMO for the Butterfly Network, notes a big trend impacting the acceleration of pointof- care ultrasound (POCUS) is the increasing number of AI companies building applications to run on POCUS devices.

“These companies recognize a major shift happening in health care— diagnostic imaging was once ordered by a physician, and now bedside imaging is performed by all levels of health care professionals regardless of the care venue,” he says. “AI companies understand the potential and value of tools that make image capture and interpretation easier and faster.”

That’s led to another trend, he says—the continued growth of POCUS training in medical schools and residency programs.

“It’s important to consider the experience level of the users,” Martin says. “When providers are first learning how to use POCUS, superb image quality is helpful. However, as one gets more experience, image quality becomes less important because the user is more comfortable reviewing scans and making diagnoses. In educational institutions and when training novice users, it’s best to use the most recent versions of the handhelds.”

Karley Yoder, the general manager of POCUS and digital and chief digital officer of ultrasound at GE HealthCare, notes one of the most significant trends she’s seen in handheld ultrasound is a broader population of clinicians who are using this technology in their practices.

“At first, we saw handheld ultrasound primarily adopted by nonexpert users, or users new to ultrasound,” she says. “However, we increasingly see experienced users adopting handheld ultrasound to extend their diagnostic capabilities to improve access for patients and expedite diagnoses and care delivery. These capabilities are further bolstered by AI and cloud technology that enables health care professionals to share information in real time and facilitate reporting.”

Sandeep Akkaraju, founder and CEO of Exo, notes his company saw a need for handheld ultrasound increase notably over the last few years and decided to get into the segment in 2023 to help get these systems into the hands—and pockets—of more clinics.

“We are really focused on the acute space,” he says. “It’s not just about the location, but who does the exam. How do we empower nurses to be able to use ultrasound? How do we empower [physician assistants]? That’s a challenge we wanted to solve and one that will benefit the industry.”

Cécile Brosset Dubois, CEO of Sonio, says manufacturers are striving to make ultrasound devices more compact, lightweight, and easy to carry, with longer battery life, allowing for greater mobility and versatility in various clinical settings.

“Enabling seamless data transmission on handheld ultrasound devices allows for new usages like remote monitoring, and collaborative consultations,” she says. “More broadly, wireless technologies empower health care providers to access and share ultrasound images along with patient information anytime, anywhere. Unlocking telemedicine and remote monitoring usage is particularly beneficial in underserved areas, as experts become able to easily guide less experienced practitioners in realtime, facilitating better patient care.”

New and Improved
Konica Minolta Healthcare introduced the PocketPro H2 linear wireless handheld ultrasound system in July 2023, a system that complements its existing compact, handheld systems— SONIMAGE MX1 Platinum Ultrasound System and SONIMAGE HS2 Portable Ultrasound System. The system connects to most iOS and Android smart devices and is designed to be more ergonomic and lighter, to fit the ever-evolving needs of the point-of-care practitioner.

“The new PocketPro H2 linear wireless handheld ultrasound system is optimized for musculoskeletal, pain management, vascular access and needle guidance applications,” Hoggle says. “PocketPro H2 is the ideal handheld ultrasound for rapid and confident assessment of soft tissue, including tears, inflammation and instability in the joints, muscles, ligaments, tendons, and cartilage.” The handheld device also includes remote installation and support, as well as access to the company’s educational offerings.

GE HealthCare’s Vscan Air, a color, pocket-sized ultrasound first introduced in 2010, provides clear image quality in a handheld ultrasound system for whole-body scanning. “In addition to devices, software and services are increasingly vital to help users make the most of their handheld ultrasound,” Yoder says. “Vscan Air + Digital Tools [channels] workflow through cloudbased, user-friendly secure collaboration and image management tools.” Last year, the company launched the Vscan Air SL, which includes a sector-phased array transducer for rapid cardiac assessments. Both models feature a linear array transducer, bringing shallow and deep scanning together on a single, dual-probe device.

In October, Exo introduced the Exo Iris, a handheld ultrasound built on silicon technology, a new tech for the category, that Akkaraju says delivers versatile imaging performance for POCUS at a fraction of the size and cost of cart-based systems. “Iris represents a new era of ultrasound,” Akkaraju says. “It’s built to perform as easily as taking an image with a smartphone.”

Earlier this year, Butterfly launched its third-generation handheld probe: Butterfly iQ3. “Butterfly iQ3 offers the world’s fastest digital data transfer and improved ergonomic design,” Martin says. “Compared to our second-generation device, the iQ+, this new device has a 17% smaller probe face, charges in less than half the time, scans longer, and has new programmable buttons that make capturing images much more efficient.”

Butterfly iQ3 also has new and advanced 3D imaging capabilities— iQ Slice and iQ Fan—which are designed to make image capturing easier. “iQ3 marks a major turning point for Butterfly and digital ultrasound,” Martin says. “With iQ3, digital ultrasound has caught up to traditional ultrasound.”

An AI Evolution
Additionally, in response to the rapid acceleration of AI tools, Butterfly introduced Butterfly Garden, a software development kit platform that enables AI software developers and companies to build and develop custom AI applications that run on Butterfly’s platform. “Most of these algorithms are directed toward image capture and/or image interpretation, helping reduce the complexity of POCUS and enabling faster adoption to an ever-expanding number of users,” Martin says.

Clarius Mobile Health has often heard from customers that the biggest hurdle to adopting ultrasound is the challenge of analyzing images correctly. With that in mind, the company has introduced T-Mode AI, which enhances a grayscale ultrasound image using distinctive colors, patterns, and labels to teach clinicians how to instantly identify anatomical tissues and structures during an ultrasound exam. Both wireless and pocket-sized, Clarius’s new handheld ultrasound scanners deliver high-definition imaging and performance of traditional ultrasound systems at a significantly lower cost.

“We’ve removed wires, improved image quality, and shrunk scanners to the size of an iPhone,” says Clarius founder Laurent Pelissier. “And we’ve been using AI to make them easy to use.”

Sonio is currently working on the development of AI-driven software for handheld ultrasound enabling practitioners everywhere, even those who are not OB/GYN ultrasound experts, to answer critical pregnancy monitoring questions and refer higher-risk patients to adapted health care settings. “Our platform is agnostic with ultrasound machine manufacturers, making us the AI partner that can seamlessly integrate with existing ultrasound machines and adapt to the evolving needs of prenatal practices,” Dubois says.

Martin says medicine has followed a highly specific script for generations, regardless of the care setting,: history, physical, and then pause. “During the ‘pause,’ clinicians decide if they have enough information to make a clinical decision or if they need more information,” he says. “As many of us know from personal experience, physicians often need more information, and that pause and subsequent delay for testing, can create inefficiency, cost, and frustration for both patients and health care professionals. Handheld ultrasound technology has ushered in a new script for providers: history, physical, and image immediately.”

Improvements Ahead
Handheld ultrasound technology is increasing so rapidly, Hoggle says, that clinics should consider replacing units every two to three years, as opposed to six or seven years for standard ultrasound. “Many doctors could be using it similar to a stethoscope in the near future,” he says. “Continued enhancements in image quality will continue to drive adoption by different medical specialties and by first responders or home health care providers. AI driven workflow, calculations, and diagnosis will continue to be an area of development and innovation.”

Akkaraju feels there will be a revolution of AI technology in handheld ultrasound in the not-too-distant future, and the company is already working on incorporating more into its system.

Martin believes that the future of handheld ultrasound technology has already been set in motion and is inevitable. “It’s only a matter of time until providers across all specialties in all care venues leverage POCUS with handheld devices in their clinical practice,” he says. “AI tools will also become a critical aspect of POCUS use, making superb image capture and image interpretation a skill widely available to all users. Additionally, these technological advances will cross rapidly from the developed to the developing world, helping bring imaging to all corners of the globe.”

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a frequent contributor to Radiology Today.