Last month, Celestron announced that they will not be manufacturing the TetraView or PentaView microscopes until May 2022 at the earliest. This is extremely disappointing as, up until June, they had been promising delivery by the end of July.
All customers currently waiting on the TetraView are advised to find alternative products, and buyers should be vigilant about any company taking orders for the TetraView at this time. The industry is now fully aware that there is no stock being delivered until next year. This applies to companies in the United States as much as in the United Kingdom – it is a worldwide supply problem. You can read a previous discussion of the long-term supply chain impacts of Covid in our industry in this article from June.
Alternative microscopes for cytology
After consultation with industry experts, we have sourced an alternative with the correct lenses needed for cytology. This microscope has been on the scene for a while already, but not with the ideal lens configuration. We have been testing the ScopeX Cytology Microscope with our customers who have been waiting on the TetraView, and are delighted to report that feedback has been extremely positive. We have also set up a new, dedicated Facebook group here for sharing images and experiences from the ScopeX and iSperm microscopes.
Users of the ScanX® can now have their images automatically backed up to the cloud so that they can access their files from any device.
How is the ScanX® revolutionising video saving?
The ScanX® allows you to save extra long video clips (example below). Clips of over 15 seconds in length are unheard of in scanners sold for under £6000, yet the ScanX® can save clips up to 40 seconds in length. This saves you from having to repeatedly save multiple clips for your clients and then piece them altogether afterwards.
What’s more, with the new automatic syncing feature, you don’t have to worry about uploading your scans in order to share them. They’ll already be there on Google Drive for you, accessible from your mobile phone or laptop at the click of a button.
If you’d like to be one of the first to try out this new feature, please send us a quick email to book yourself in for your upgrade. This will be done remotely and does not require you to do anything except for you to give our engineer permission to connect to your device.
If you already have your own space from which you are offering medical and beauty treatments, you may be considering adding a pregnancy scanning service for women. Before you go investing over £20,000 in an obstetric ultrasound machine (and for the type of machine being used by sonographers in the NHS, expect to spend a minimum of £50,000), you need to think seriously about the service you plan to offer.
Many aesthetics clinics employ nurses and other medical professionals to deliver regulated or more invasive treatments, and it’s important to remember that obstetric ultrasound is no different. Ultrasound involves sending energy into the body, and in the case of pregnancy scanning, you are directing that energy towards a human being at their most delicate and vulnerable time of life: the unborn baby.
The British Medical Ultrasound Society (BMUS) stresses that ultrasound should be used by trained professionals for diagnostic purposes only, and not for entertainment value (i.e. taking “pretty pictures”). This is unlikely to deter people from seeking 3D and 4D pregnancy scans, however, which at the present time are rarely provided by the NHS – hence the rise of private clinics offering this service.
There is nothing wrong with helping people to celebrate and commemorate something that, to them, is one of the happiest events of their lives, but it is equally important to do this while keeping them, their baby, and your business safe. “A trained professional” in this instance can be no other than an obstetric sonographer, and such an individual will know the correct settings to use at different stages of pregnancy, maximum safe exposure times (as well as being proficient enough to be able to obtain the required images quickly), and will also know how to spot signs of foetal distress or an abnormal pregnancy for instant referral.
An unqualified individual – however well-meaning – would not know any of these things, and such a scan may provide false reassurance to a client who uses your service in place of making an NHS appointment. The ethical and legal ramifications of this need no elaboration.
Ultimately, if investing tens of thousands of pounds in an ultrasound machine, it just makes sense to employ a sonographer to perform the scans. The average hourly rate of an obstetric sonographer in 2021 is £60/hour, but you will not have to invest anything in training them up, they will be able to get the most out of your new machine, and you will be able to sleep at night.
If you need help or advice in choosing the right ultrasound machine for your business, please contact us.
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.