This is my review of the GE VScan- arguably the smallest ultrasound machine so far. The BBC called it a huge step forward for clinical practice.


The machine is as big as an adult hand, and has a clam shell. Flipping the shell open turns the machine on instantly, and closing it turns the machine off. Once the machine is on, it creates a study, but you don’t get an option to enter patient details. 


Presets


The machine has 3 presets: cardiac, abdomen and pelvis.


The cardiac preset saves images in MP4 movie mode, and you can review the cine loops as you would any echocardiographic study. The abdomen and pelvic preset saves images in JPEG format, but does not allow saving of movie files. Changing different presets alters the depth of penetration and optimises visualisation for certain structures. You do not have to do very much to adjust gain transition once you have selected a preset (and there’s no option to do so anyway).


Colour doppler is available on all presets, allowing evaluation of blood flow. 


Display


For a portable ultrasound unit, it comes with a fast frame refresh rate- good enough for grayscale and colour doppler echocardiogram applications. The screen is a little small- about the size of the Iphone screen, but it’s clear and bright enough to see in normal room light.


Colour doppler is comes with the presets, and once activated, you cannot alter the sensitivity. Moving the doppler box is a little fiddly, as you have a fixed box, and you can only move it around the frame. This means that you cannot cone down to a small vessel. The cardiac doppler functions are probably adequate.


Transitional gain is fixed for whatever preset you are using. For example, trying to optimise viewing of the liver on the cardiac preset will be frustrating for new users. It’s better to simply select the abdomen preset, and let the machine optimize the images. 


You also cannot adjust the focal zone. The machine allows you to zoom in and out of the area of interest, but you lose image resolution the larger you zoom. Since you only have a curved array probe, the range of magnification is limited to the first 5-6 cm of the scan plane- so it’s not suitable for viewing superficial structures.


Image quality


Images are saved as JPEG format, not DICOM. Hence, you cannot change the brightness and contrast settings on the fly. It’s probably not a big deal for ultrasound because we often do not alter the window settings- but archiving images into a radiology PACS will only give static images. This decision probably reflects the fact that the target audience for the VScan are clinicians, who will use the VScan as a clinical office tool. The machine comes with a 4GB SD card for storage.


Resolution is 320 x 240 pixels, resulting in a JPEG file of about 15-16 KB per image capture. Movie files (cardiac function) are saved in MP4 format, and you can record up to 1 minute of video.




The images are somewhat “raw”, reminiscent of the ATL HDI5000 images, before the advent of harmonic imaging. Tissue interfaces lines are very distinct, and this is very useful for a machine like this.


The images are stored in folders, on the card but the folder labelling system is not intuitive- and does not allow for easy identification of the studies within at a glance. GE can probably look into renaming the folders by time and date of acquisition. Image transfer is really easy, as you simply drag and drop the folders as you would with a digital camera. Such ease of transfer also means that patient identities can be compromised if you lose the SD card- but the current setup does not allow patient identifiers to be input at present. So this is not a big problem. Once patient identifiers are entered, though, a safer way would be to enable image transfer after authentication either through software or hardware authentication.


Portability


It’s a really light machine, and comes in a small case. This makes it ideally suited to bedside applications. The probe is light, with a nice ergonomic feel. Battery life, is good. During intermittent scanning throughout the day, the battery only needed to be charged once- and it took about 45 minutes to fully charge. It remains to be seen how long the battery life will be, before it requires replacement. I remember using a GE Logiq book many years ago, and the battery life on the machine was awful- to a point where it would run down its charge in 15 minutes. Innovations in battery technology have moved on since then, and I hope this applies to the Vscan.  


The charger sits in an oversized plug. You either plug it into a charging plate, or into the Vscan to charge. The test unit had a rather flimsy adaptor on the charge plate, so much so that the plug could wobble up and down- but thankfully, did not disconnect.


CONCLUSION


This is a nice little machine that can be useful for bedside examination of the heart, abdomen and pelvis. In an acute situation, you can probably perform a quick exam to look for fluid in the abdomen. You can also examine the heart, and visually gauge the degree of valve dysfunction or contractility. 


It’s not released for sale in Singapore at the moment- but this is coming soon. Commercially, it would make sense to avail the machine to anyone with a low enough budget- but they may not upgrade to a higher-margin scanner after buying a Vscan.

(Images courtesy of Fujifilm, Singapore)


The kind folks at Fujifilm invited us to a talk featuring their new Amulet digital mammography system. It boasts the smallest pixel pitch of 50 microns - which means more detailed images. It integrates with Fuji's CR system and the Synapse PACS.


Download the brochure here.

The new top dog in computed tomography (CT) is the Siemens dual source (64-slice x 2) Somatom Definition Flash scanner.


Siemens AG provide an official press release, touting the unique use of dual source technology to reduce dosage and scan times (click on this link). They don't talk very much about characterizing urinary calculi anymore ;) 


It's noteworthy that the one of the first installations of the scanner was at the Arnold Palmer (paediatric) Hospital - and makes an impressive claim of sub-mSv dosage cardiac scanning (when most scans are in the 8-30 mSv range). And 75ms temporal resolution which reduces the requirement for B-blockers.


The exterior of the machine is iMac white, with a shiny plastic clad front panel, and Siemen's characteristic horizontal zebra slides. Very pretty.


We can't tell you where exactly it is until the official announcement, but if you wander about Paragon Medical on Orchard Road, you might find it.


Here's a podcast from Elliot Fishman from ctisus.com on Johns Hopkins' initial experience with the Flash.

We had a peek at the new award winning Philips 256-slice scanner (Brilliance iCT) at the Singapore General Hospital. It promises the features to be expected from a larger detector field- greater coverage and speed, allowing cardiac CT with step and shoot, near-real time angiography, lung volumes and virtual colonoscopy.

Here's a short writeup from Philips Medical.

A Youtube video of the spinning gantry:

Philips Medical Singapore is making the rounds at our institutions, demonstrating the latest addition to their ultrasound machines: the portable CX50.

It's built on the same engine as the legendary IU-22 (which was introduced in 2005, and still going strong!), but thanks to miniaturization technology, comes as a cart system. There's SonoCT and XRes.

The laptop sized processing engine can be detached, and taken to the wards. There's also an option to connect the CX50 to the Allura angio suite, allowing the ultrasound machine to output on the multimonitor display wall.

How did we like it?

We ran a session with the CX50 with Philips' app specialist, Rachel, and a couple of doctors the other day. The system was fast, and image quality for musculoskeletal work (done on patients in the weight range of 60-80 kg) was very good. As good as the IU? Perhaps. But the proof is in scanning the larger patient- and I found the refresh rate slower than the IU when depth was increased. That's the trade off for portability.

Here are some images from Philips Medical Singapore (thanks, Rachel!). Sure- they are for marketing purposes, but I can tell you that the quality is preetty good- approaching that of the IU22!