A staple of radiology for decades, ultrasound systems continue to advance technically and ergonomically, presenting physicians with an often onerous, but clinically worthwhile, selection of new scanners, according to the authors of an article published in the July issue of the Journal of the American College of Radiology.

The first step is to attain a solid grasp of the practice’s mix of exams, workflow and clinical needs. This involves considering the frequency of various exams; prevalence of portable imaging; mix of diagnostic work and procedures; teaching; and the provider’s IT environment, explained Nicholas J. Hangiandreou, PhD, and colleagues from the department of radiology at Mayo Clinic in Rochester, Minn.

This process, and all other steps in the selection of a new system, must include the entire ultrasound team, including radiologists, sonographers, medical physicists, technical services personnel and administrators. Gauging the department’s needs will help navigate the array of technical offerings available between systems, which include advanced visualization, electromagnetic transducer tracking systems, lesion tracking and transducers geared towards various exam types, argued the writers.

Another early consideration should be ergonomics and usability. Careful selection of features can help reduce repetitive stress injury, while also enhancing the consistency and efficiency of exams, added Hangiandreou and co-authors.

Equally important are a system’s technical features. Grayscale display calibration can help ensure that images taken in the scan room match those viewed later in PACS, an important clinical consideration. Moreover, the capacity for remote diagnostics, co-registration of scanner settings and vendor service options may expand a practice’s capabilities.

“In general, even if many features that are offered on a particular system are currently of limited value to your clinical practice, assessment of the availability of cutting-edge features is a useful measure of the creativity and innovation of the equipment vendor and the future potential for the scanner,” offered Hangiandreou and colleagues.

With these criteria in mind, the authors underscored a critical advantage of ultrasound portability and safety: the opportunity to test systems before purchase. “[T]he value of hands-on experience using a system before purchase cannot be overemphasized,” Hangiandreou et al stated.

Testing can include phantoms, volunteers or, ideally, consenting patients. Solid planning (based on the institution’s selection needs) can make this process dramatically more effective, the authors added.

A helpful method is to evaluate images captured with the new system against the current one, which can serve as the gold standard. A scale ranging from superior quality of the new system (a score of one) to clinically unacceptable images from the new system (a score of four) can help objectivize this process. Hangiandreou and colleagues emphasized that, although new features or variations can be off-putting initially, their potential value should not be disregarded.

Acceptance testing should be the final step, often falling under areas like connectivity, display performance, mechanical integrity and image quality.

The underlying framework for purchasing the best possible system, maintained Hangiandreou and co-authors, is to involve all members of the clinical ultrasound team.