I met with Paul at Celestron yesterday, and the top question on my agenda was of course to find out when we can expect delivery of our latest order of microscopes. Paul reiterated to me what we already knew, which was that the delay is caused by the global shortage in computer chips: a situation that appears to be getting worse long before it gets better. Celestron’s lead time on its high-end telescopes is now 630 days, so in that respect, we should be counting ourselves lucky.
Having originally given us a delivery estimate of “by the end of July,” it is quite clear at time of writing that this is not going to happen. Paul was reluctant to give a revised delivery time, except to say that it was “imminent” and that he was chasing it on a daily basis. Celestron are aware of the number of customers we have waiting for the TetraView and how important our customers are to us, and assured me that no company will be receiving delivery or even notification of delivery before us.
I am really desperate – what can I do?
I know that some of our clients are desperate to start performing cytology, and the delay on the TetraView is harming their business. I asked Paul what Celestron could offer these clients, and he suggested that if any of you already use an external monitor for your ultrasound scanning or sperm analysis, or alternatively a laptop, the MicroDirect 1080P could be a great alternative. The images are just as spectacular as the TetraView: the only difference is that it does not come with its own monitor (hence the need to connect it to an external monitor via HDMI, or a laptop). At £159 (free delivery), it’s also considerably cheaper than the TetraView.
If any of you are desperate to get going but know that you ultimately want the TetraView, and simply want to borrow a MicroDirect 1080P until the TetraViews are in stock, please email Dativa or get in touch via our webform. We do not typically loan out equipment but we appreciate the situation everyone is in right now, and will do whatever we can to help. In this instance, you would pay the full price for the MicroDirect, but this would then be deducted from your purchase of the TetraView once they are in stock (minus a slight depreciation cost and our delivery and return costs to you).
Long lead times are here to stay
Anyone who has been on the waiting list for a TetraView microscope for a while, or even a ScanPad+ ultrasound machine, already knows too well the ways the global chip shortage is hitting our industry. But we are not alone: electronic chips – such as the memory chips Celestron are waiting on to be able to ship out their TetraViews – are found in mainstream products such as televisions, cameras and cars. Ordering a new car and receiving delivery within a few weeks may soon become a distant memory, with lead times for new cars rising up to 6 months.
The knock-on effects of Covid-19 are going to ripple throughout the global supply chain for a long time to come, and many are predicting that it will take at least two years for supply to return to a relatively normal level.
Ultrasound guidance can improve accuracy for needle biopsies, vascular access, nerve blocks, administering anaesthetic, or steroid or medicine delivery for musculoskeletal (MSK) and podiatry applications. Through visualisation of surrounding structures, it can also improve procedure safety.
However, it is a difficult skill to master, and requires a lot of practice. To aid with this, manufacturers of higher end systems offer needle guidance software on their machines – for example, on the Apogee 1000 Lite. As well as optimising machine controls (turning on spatial compound imaging and often turning off tissue harmonic imaging), this algorithm electronically steers the ultrasound beam to make it as close to perpendicular to the needle as possible (Cheung & Rohling, 2004).
Above left: Before needle enhancement is active. Above right: After activating needle enhancement on the Siui Apogee 1000 Lite.
Performing ultrasound-guided needle procedures
The needle can be advanced in plane or out of plane. Either approach is equally valid. The in-plane approach results in the needle being seen advancing across the imaging plane, as you might expect. This is more difficult than it sounds because the beam width is very narrow. Visibility can be improved by approaching at a shallower angle (with the needle at 90° to the beam being optimal), in order to maximise the amount of reflected energy that returns to the probe. This is because the needle is a smooth, specular reflector – think of it like a mirror. With the needle at 180° to the beam, there is no surface for the ultrasound to reflect off. At close to 180°, any reflections will be directed out of plane, and will not return to the transducer. Where deeper nerves are being targeted and an angle close to 180° is inavoidable, the operator can press one side of the transducer deeper into the skin to help to adjust the angle.
If you do not have needle enhancement on your scanner, the following will improve visibility:
- Turn spatial compounding on (if you have it). This allows the ultrasound machine to acquire multiple images of the same region from slightly different angles, and sum them together. This eliminates artefacts as they won’t be present from one angle to the next (they’re not “real”), but strengthens the signal of genuine reflectors, like your needle.
- Turn tissue harmonic imaging off. THI has been shown to worsen needle visibility (Chin et al., 2008), possibly because of the fact that it narrows an already very thin beam even further (Reusz et al., 2014).
- Use echogenic needles. It is possible to obtain needles designed specifically for visualisation on ultrasound. They are made with rough surfaces (on the scale of a wavelength) so that they scatter ultrasound energy in all directions, increasing the amount of energy that returns back to the transducer, regardless of angle of incidence.
The out-of-plane approach involves positioning the transducer over the target region, entering the skin to the side of this area and looking for the needle tip as it enters the imaging plane (and therefore the target). There is some evidence to suggest that this approach is easier for beginners, but the downside is that you do not see the whole needle at once. If you are not confidence in fanning your probe, you may find it difficult to identify the tip of the needle, as it will not look any different from this projection to the shaft.
If you are considering purchasing an affordable MSK ultrasound machine, please get in touch. We are approved NHS suppliers, and have extensive experience supplying hospitals, universities and research teams in both human and veterinary medicine.
Cheung, S., Rohling, R. (2004). Enhancement of needle visibility in ultrasound-guided percutaneous procedures. Ultrasound Med Biol. 30(5):617-24.
Chin, K. Perlas, A., Chan, V., Brull, R. (2008). Needle Visualization in Ultrasound-Guided Regional Anesthesia: Challenges and Solutions. Regional Anesthesia and Pain Medicine, Vol 33, No 6: pp 532–544.
Reusz, G., Sarkany, P., Gal, J., Csomos, A. (2014) Needle-related ultrasound artifacts and their importance in anaesthetic practice. BJA: British Journal of Anaesthesia, Volume 112, Issue 5, Pages 794–802.
The rise in dog and puppy theft is well known, but it seems the criminals are now widening their attentions to the equipment that accompanies dog breeding – which includes ultrasound machines.
There has been a spate of credit card fraud recently, with at least three ultrasound machines that we are aware of having been purchased with stolen credit cards (thankfully, none from our company so far this year, in part due to our rigid procedures when it comes to accepted payments types and in-person collections, having been victims of fraud ourselves in 2019). On top of this, two of our customers have told us that they’ve had ultrasound machines stolen from their vehicles.
When considering purchasing a used ultrasound machine:
- Buy from an ultrasound company. You won’t pay very much more than buying privately (you might even pay less!), and you’ll get the peace of mind of knowing the machine is legitimate, with warranty, and you will be supported and looked after. You can view our used veterinary ultrasound machines here.
- If you must buy privately, ask the seller for proof of purchase, or verify the serial number with the company they purchased it from.
Remember that ultrasound machine warranties do not automatically transfer. That means that even if you buy a machine that was purchased only yesterday by somebody else, the company will not be able to provide you warranty repair unless their engineers have checked the machine over prior to you taking possession. That is why buying from a private individual is always high risk.
If someone is offering you a ‘too good to be true’ cash deal for a brand new machine, this should raise suspicions. If you think you might have been approached by somebody offering you a stolen ultrasound machine, please let us know about it.
The quality and safety of our equipment is our top priority, and as a dedicated ultrasound company run by specialists, we take this responsibility seriously. Just as we source equipment through careful field testing by sonographers, feeding back necessary changes to manufacturers to ensure all of our machines are optimised for their intended use, we also make sure the safety readings on our scanners are true and accurate.
How is the mechanical index measured?
Ultrasound transducers send out pressure waves which oscillate between positive and negative pressures. It is this rapid pressure oscillation that has the potential to cause biological harm. Extreme negative pressures can bring gas out of solution in the blood and tissue, which can then explode as the pressure rapidly rises: similar in concept to the way that a diver gets ‘the bends’ from a rapid change in pressure.
The mechanical index is calculated from the peak negative pressure of the ultrasound beam (adjusted to account for the level of attenuation that would be expected in soft tissue), divided by the square of the frequency. It should be calculated and monitored by all ultrasound machines, should ideally be displayed on screen for the operator to monitor, and should never exceed 1.9 for normal ultrasound scans. For pregnancy scanning, users should be even more cautious.
An ultrasound transducer’s mechanical index (MI) is measured using a hydrophone in a water tank, which is lined up with the beam. An oscilloscope displays the waveform, pictured below. From this, you can see that it is true that an ultrasound transducer emits a pulse of ultrasound, consisting of more than one cycle.
The MI of the two scanners tested was well below 1, which makes them ideally suited for abdominal scanning in small animals.
Finger On Pulse Ltd. (trading as PortableUltrasoundMachines) was awarded its trademark on the 22nd of January 2021, protecting the ‘ScanX’ name for the next ten years.
The ScanX ultrasound machine utilises the much-loved ScanPad software and interface, but has been adapted for use on a portable, WiFi-enabled tablet device.
While no trademark or design right registration will ever prevent others from copying, this trademark can reassure customers and partners that they are buying “the real thing” and enables us to continue our work and investment in improving the ScanX® year upon year. The ScanX® project has already put together an international team of professionals from England, Egypt, Brazil, Romania and The Philippines, and the software and hardware is being improved all the time. Our goals for the next two years include:
- All software development and coding moved in-house, here in the United Kingdom
- Integration of new artificial intelligence systems to support users, developed in the United Kingdom in partnership with our most trusted users and partners in the UK, USA and Canada
- Sourcing of all transducer components from the UK, Europe and the United States.
The ScanX® ultrasound machine will be distributed directly through the portableultrasoundmachines.co.uk website, and through select partners/distributors. Please note that PortableUltrasoundMachines is a separate company to those whose systems we also distribute: i.e. we are separate and independent from SIUI, Kai Xin, or Vet Image Solutions (VIS).
A comparison of image quality between the ScanPad transducer and software (run via the ScanX interface), and Apogee 1000 Lite.
These two comparison scans were performed on the same pregnant guinea pig, just over one week apart. In the first set of images, pregnancy can be quickly and easily confirmed on the ScanX, but the higher resolution of the Apogee system really shows in the detail and crispness of the tissue boundaries.
In this next set of images taken eleven days later, strong heartbeats can be seen with the ScanX, with the skull and spines of the pups clearly visible. The Apogee 1000 Lite really takes things up a level when it comes to detail, however; highlighting every rib, and you can even see the brain inside the fetal skull.
It’s important to also stress that both of these scanners were operating at very low power settings. You can read more about how to safely scan very small animals in this article from the Animal Ultrasound Association.
This year saw the launch of the new ScanPad+ ultrasound machine – to the delight of some, and the dismay of others. It followed months of Coronavirus-induced supply issues, as parts suppliers of the original machine fell by the wayside or suffered unprecedented delays. This was by no means exceptional during this time, and was a phenomenon that affected supply chains all around the world. This was compounded by a surge in demand from online companies, overloading shipping and delivery companies, which only added to delays.
The only way to continue to produce the ScanPad was to raise prices significantly, and so VIS (the creators of this machine) decided that the only viable option was to introduce the ScanPad+. This machine saw the introduction of a number of improvements that North American clients, in particular, had been asking for.
Key differences between the ScanPad+ and ScanPad
The main goal behind the creation of the ScanPad+ was to change as little as possible. The ScanPad is arguably the best selling ultrasound machine for small animal pregnancy scanning worldwide, and the number of imitation products both at home and abroad is a testament to its success. For that reason, the software, main board and transducers remain completely unchanged in the new unit. The main differences are:
- Much sturdier case: This is something that people who tend to scan outdoors had been asking for for years, particularly goat breeders in the USA and dog breeders in Canada.
- Custom-made carry case: Finding an appropriate carry case for the ScanPad was always problematic, so the ScanPad+ can be ordered with a case designed especially for this machine.
Above: Original ScanPad (left), and the new ScanPad+ (right), launched 2020.
What about the ScanX?
The ScanX ultrasound machine is a new product that will officially launch in January 2021, although a few people have taken advantage of currently discounted pricing to buy theirs now (current lead time of one week). The aim of the ScanX is to improve upon two main weaknesses of the ScanPad or ScanPad+:
Portability: Some people argue that the increased robustness of the ScanPad+ comes at a price: it’s a bulkier, heavier machine than before (4.8kg / 10.5lbs). In addition, the battery life of the ScanPad series has never been impressive, nor is it meant to be. The battery is there as an emergency backup for a machine that’s designed to be run from the mains. The ScanX, in comparison, is super lightweight (well under 1kg / 2.2lbs), with a battery that will keep you scanning for at least five hours.
Service and repair: The collapse of global supply chains during the first wave of the Coronavirus pandemic was a huge wake-up call. In countries like the UK, USA and Canada, we rely heavily upon trade with other nations, and when component suppliers cease trading, increase prices or shipping gets delayed, it causes major problems. While the interconnectedness of our world means we can never eliminate this completely (nor would we want to), there are steps we can take to improve things:
1) On the computing side, the ScanX is powered by systems designed and supported by big companies with a strong presence in the United Kingdom and North America (e.g. Microsoft).
2) The ScanX software is coded and supported from right here in London.
3) Training and technical support can be delivered remotely, from London and from our amazing Clayton in Brazil who is on the same time zone as most of our American clients.
4) Our high resolution transducers are assembled and printed in Surrey, England.
This reduction in the number of external components also means that there is less to ‘go wrong.’ No more waiting on spare parts – both the tablet and transducer are individually warrantied and, in the event of a malfunction under warranty, you would simply receive a replacement. If your tablet device were ever to fail outside of warranty, the fantastic thing about the ScanX is that the software can be installed on any Windows or Android device, enabling you to carry on scanning.
Of course, the ScanX won’t suit everyone. One of the most popular features of the ScanPad range is the huge 15″ screen – something that is inevitably lost on a more portable unit (the ScanX screen is 10.5″). You can learn more about the ScanX Ultrasound Machine here.
Comparison of a feline kidney imaged first with a microconvex (at 5.2MHz, with harmonics turned on) and then with a linear probe (at 12MHz) on the Siui Apogee 1000 Lite.
Below is the same structure in a French Bulldog, imaged on three leading ultrasound machines, all of which are popular for abdominal scanning in small animals – and particularly for canine pregnancy scanning.
This highly portable machine is popular with fertility clinics and well-established mobile pregnancy scanning businesses who demand the best.
The below image was taken with harmonics turned on, at 4.5MHz.
The ScanX ultrasound machine comes with its own software app, allowing you to run it off any Windows laptop or Android device.
This was taken with a microconvex probe, at 6.5MHz.
The Elite 5600 is a popular entry level machine for dog pregnancy scanning due to it ease of use, reliability, and excellent image quality for a sub-£2000 scanner.
It was set at the highest frequency available with its default convex probe (higher frequency microconvex probes are available upon request).