Ultrasound is playing a key role in enhancing patient care and shaping the radiology landscape in the country
Ultrasound is playing a pivotal role in revolutionising diagnostic imaging, elevating the standard of patient care, and molding the radiological landscape in the country.
Its non-invasive nature, real-time imaging capabilities, and versatility have made it a preferred choice for various medical conditions. The increasing availability and affordability of ultrasound technology have played a pivotal role in its widespread adoption, contributing significantly to the growth of radiology services throughout the country.
Dr Arvind Gupta Medical Director, Primus Super Speciality Hospital shares, “ultrasound technology has undergone significant evolution in the Indian healthcare system over the years. Initially introduced for obstetric and gynecological purposes, ultrasound quickly expanded to various medical fields. The technology became more widely accessible, leading to increased usage in diagnostics across specialties such as cardiology, radiology, and gastroenterology. The evolution involved the incorporation of advanced imaging modalities, improved resolution, and enhanced portability, making ultrasound a versatile and indispensable tool in healthcare settings.”
Stressing on the growing market of ultrasound, Dr Saurav Bhagat, Radiologist, Prayag Hospitals Group said, “The India ultrasound devices market is expected to experience substantial growth, with a projected increase from USD 231.86 million in 2023 to USD 316.18 million by 2028, representing a CAGR of 6.40 per cent. The COVID-19 pandemic has played a role in driving this growth, with increased use of ultrasound for diagnosing and monitoring COVID-19 cases. The rising burden of chronic diseases, particularly tuberculosis, contributes to the growing demand for effective ultrasound diagnosis. Major market players are actively introducing new and advanced ultrasound equipment, further propelling the industry’s expansion.”
“The portable ultrasounds segment is anticipated to hold a significant share over the forecast period, driven by factors such as advanced technology, a growing geriatric population, and increased awareness. Additionally, the 2D ultrasound devices market is expected to grow due to factors such as increased cancer prevalence, technological advancements, and a rising birth rate. Overall, these trends underscore the pivotal role ultrasound is playing in shaping the future of radiology in India, with a focus on portability, technological innovation, and the diagnosis of various medical conditions”, he added.
Evolution of ultrasound in the Indian healthcare system
The evolution of ultrasound technology in India has been marked by continuous innovation and technological advancements. From basic 2D imaging, the introduction of 3D and 4D imaging has allowed for more detailed and accurate visualisation of internal structures. Doppler ultrasound, which assesses blood flow, has become a crucial tool in cardiology, obstetrics, and vascular medicine. Portable and handheld ultrasound devices have also made diagnostic imaging more convenient, especially in remote and underserved areas.
Talking about the evolution timeline, Dr Janardhan Reddy, Consultant-Radiology, SRV Hospitals, Mumbai said, “ultrasound as an imaging modality was introduced in India at around in the 1980s, though predominantly in metro cities. Initially, ultrasound as a diagnostic application was limited to only a few due to its cost & availability. The uses of ultra-sound were limited due to poor resolution, bulky & expensive equipment. However, as time went on there was a gradual improvement in overall technology including processing power, transducers architecture and image processing algorithms with resultant reduction in size & cost of ultrasound machines in India. In one generation itself we progressed from 2D to 3D and even 4D being quite commonly available. Few of the new machines are able to resolve thinnest of nerve fibers, muscles, tendons & smallest of blood vessels.”
Moreover, the diversification of ultrasound applications has broadened the scope of radiology practice in India.
Dr Anita Aggarwal, Director & Chief of Radiology, Indian Spinal Injuries Centre, New Delhi also mentions, “Ultrasound has undergone a significant evolution within the Indian healthcare system, becoming a cornerstone in diagnostic imaging. The integration of wireless technology has played a pivotal role in this evolution, offering a seamless flow of data and eliminating the constraints of physical connections. Modern probes enable radiologists to conduct ultrasound procedures without the discomfort of cords, contributing to increased efficiency. Additionally, the shift towards cloud-based systems has further propelled the evolution, providing healthcare facilities with enhanced process efficiency, financial predictability, and long-term cost savings.”
Technological revolutions and advancements
The radiological growth of India has been significantly shaped by technological revolutions in ultrasound. Advancements ranging from high-frequency probes to portable devices and the integration of Artificial Intelligence (AI) have not only enhanced diagnostic capabilities but also broadened accessibility, ultimately reshaping the landscape of patient care.
These technological revolutions in ultrasound are emerging as a driving force behind overall transformative journey.
On this, Chander Shekhar Sibal, HOD & Vice President of Healthcare Business at FUJIFILM India shares, “Innovations like high-resolution imaging, 3D/4D imaging capabilities, and portable devices have enabled more accurate and detailed diagnoses in India. Moreover, the integrated advanced imaging modes and automated features of ultrasound technology have enhanced the precision and efficiency of diagnostic procedures.”
Dr Gupta explains how technological advancements have improved the accuracy and scope of ultrasound examinations, contributing to better patient outcomes. He mentions, “the technological revolutions in ultrasound in India have been marked by advancements in transducer technology, image processing, and machine learning algorithms. High-frequency transducers with better resolution and 3D/4D imaging capabilities have become commonplace. Doppler ultrasound, once a revolutionary addition, is now standard for assessing blood flow. Moreover, elastography and contrast-enhanced ultrasound have provided additional diagnostic capabilities.”
Dr Rolly Chowdhri, Consultant, Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai mentions, “ultrasound technology has seen significant advancement. Today, ultrasound technology enables 3D imaging and includes wireless transducers. Radiologists can use app-based technologies to reach a quick and accurate diagnosis. The output can be integrated with CT/MR outputs with fusion technology, allowing for synchronised imaging and improving the detection of lesions and the performance of minimally invasive procedures. The High spatial resolution of ultrasound machine is aiding in reaching the correct diagnosis.”
“There is also laparoscopic ultrasound which allows the surgeon to look into the tissues being operated upon, thereby compensating for the inability to physically palpate the organ or lesion. Shear wave elastography Shear wave elastography (SWE) is an ultrasound technique that measures tissue stiffness and is used to evaluate liver stiffness caused by liver cirrhosis. Contrast-enhanced ultrasound (CEUS) uses an intravenous contrast agent to improve the visualisation of blood vessels and organs”, she added.
While technological revolutions in ultrasound have propelled the radiological growth in India, challenges persist. Adequate training of healthcare professionals to harness the full potential of advanced ultrasound technology remains a priority. Addressing these challenges presents opportunities for the development of comprehensive training programs, fostering a skilled workforce capable of maximising the benefits of cutting-edge ultrasound advancements.
AI integration: Improving diagnostic precision in radiology
Incorporation of AI into ultrasound technology is improving diagnostic precision in radiology many folds. Intelligent algorithms also help in analysing the ultrasound images accurately, aiding healthcare professionals in identifying the abnormalities and overcoming the challenges that might not be able to happen via traditional methods.
The result is a considerable improvement in diagnostic accuracy, offering radiologists a more reliable foundation for decision-making.
Dr Vipula Potdar, Consultant-Radiologist, Jupiter Hospital Pune said, “The integration of AI in handheld ultrasound devices addresses the challenges of usability and image optimisation. AI aids in enhancing image quality and guiding probe orientation, thus significantly reducing the learning curve for new users and allowing more focus on patient care. AI-integrated ultrasound systems demonstrate a marked increase in diagnostic accuracy and a reduction in false positives.”
The integration of AI is also helping in streamlining radiological workflows by offering advanced tools for image interpretation and analysis and better efficiency of the diagnostic process. This, in turn, allows radiologists to focus their expertise on complex cases, with routine tasks being efficiently managed by AI algorithms.
On streamlining radiological workflows, Dr Divya Kant, Consultant –Radiologist, Asian Hospital Faridabad also shares, “The advent of portable and handheld ultrasound devices has democratised diagnostic imaging, especially in resource-limited settings. These compact devices offer flexibility, enabling healthcare practitioners to conduct point-of-care examinations conveniently. Their impact is particularly pronounced in rural areas, where accessibility to traditional imaging facilities is limited, ensuring that quality healthcare reaches every corner of the country.”
Highlighting the Synergy of AI and data mastery, Dr Ravi Kapoor, Director, Senior Consultant Radiologist, City X-Ray and Scan Clinic explains, “The intersection of ultrasound and AI has heralded a revolution in precision medicine. AI algorithms adeptly navigate extensive datasets, recognising patterns and aiding doctors in diagnosing complex conditions. From an outsider’s perspective, doctors leverage these AI-powered tools to optimise workflows, resulting in swifter and more accurate interpretations of ultrasound images. AI integration goes beyond diagnostics; it introduces predictive analytics, enabling doctors to anticipate and intervene in potential health issues before they apparent clinically. This proactive approach not only saves valuable time but also contributes to a more personalised and anticipant form of patient care.”
AI’s role in ultrasound also facilitates the early detection of various pathologies, enabling healthcare providers to intervene at the nascent stages of disease progression. Whether it is identifying anomalies in prenatal scans or detecting subtle changes in organ structures, AI’s rapid analysis of extensive imaging data supports timely and proactive medical interventions, fostering improved patient outcomes.
While the integration of AI in ultrasound presents promising opportunities, certain challenges such as ensuring data privacy, building trust in AI systems, and providing comprehensive training for healthcare professionals need to be addressed. The ongoing evolution of AI algorithms and continuous research and development efforts are expected to refine and expand applications, optimising the synergy between AI and ultrasound technology.
Dr Reddy throws light on some of the obstacles. He highlights, “recent advances in deep-learning technology have brought revolutionary changes to AI research and application across industries, yielding major innovations in radiology, which is based on the interpretation of image data obtained through various methods-and has often been compared with computer vision using pattern analysis. Image information obtained by ultrasonography provides the foundation of input data for the development of a machine learning algorithm, either using traditional handcrafted feature extraction or automated feature extraction via deep learning.”
“Despite expectations for increasing research and development of AI-empowered ultrasonography, the clinical implementation of AI in medical ultrasonography faces unique obstacles. It will be necessary to standardise image acquisition, regulate operator and interpreter qualification and performance, integrate clinical information, and provide performance feedback to maximise benefits for patient care”, he added.
Impact of portable and handheld ultrasound devices
One of the most significant contributions of portable and handheld ultrasound devices is the democratization of diagnostic imaging. These compact devices have broken traditional barriers, enabling healthcare professionals to carry out ultrasound examinations beyond the confines of specialized imaging facilities. Whether in remote rural areas, ambulances, or point-of-care environments, the portability of these devices has dramatically expanded access to critical diagnostic services.
Sharing his views, Dr Somesh Lala, Director Radiology & Imaging, Sir H. N. Reliance Foundation Hospital said, “we now have portable ultrasounds in the wards where we can assess all critical cases at the bedside, analyse effusions in all critical cases, perform Doppler ultrasounds for DVT, and handle all emergencies at the bedside. That, then, is one of the revolutions that have occurred. smaller device than the main unit, yet it performs all the functions of a bedside colour doppler, including abdominal and chest assessments.”
Portable ultrasound devices empower healthcare providers with the ability to conduct point-of-care imaging, bringing diagnostics directly to the patient’s bedside. In emergency situations, this capability proves invaluable, allowing for rapid assessments and immediate decision-making. This shift towards point-of-care ultrasound (POCUS) is particularly significant in India, where reaching specialised medical facilities may be logistically challenging.
Stressing on the advantages of POCUS, Dr Chowdhri shares, “handheld ultrasound devices (POCUS) are increasingly used across healthcare specialities due to their portability and immediate results. These devices have shown similar accuracy to cart-based machines for various applications, including bedside portable procedures and diagnostic evaluations in sick & bed ridden patients. Despite their benefits, experts identify that no single handheld device is perfect. High image quality, ease of use, portability, total costs, and availability of different probes are considered vital characteristics. However, poor image quality and limited patient movements are significant limitations, affecting clinical decision-making and user satisfaction. However, their use in India is restricted under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994.”
Widespread adoption of ultrasound technology: Impact on public health
The availability of ultrasound technology has broken down geographical barriers, making it available to broader spectrum of the population and enhancing the accessibility to critical diagnostic services.
Sibal shares, “the widespread adoption of ultrasound technology has significantly improved healthcare access and positively influenced public health services nationwide. It has contributed to early disease detection, facilitating timely treatment. Additionally, the natural nature of non-ionising ultraviolet rays makes them safer for regular use and reduces radiation exposure compared to other imaging techniques.”
There is a positive impact on maternal and child health due to widespread ultrasound adoption is particularly pronounced in India, allowing healthcare providers to monitor fetal development and identify potential complications.
Dr Chowdhri stresses that the best indicator of a developed country is the NMR (Neonatal mortality rate) and ultrasound is helping us achieve that and take a step from developing nation towards developed nation.
She added, “ultrasound has been a core part of national health programmes like National Rural Health Mission, the Rashtriya Bal Swasthya Karyakram, and the Pradhan Mantri Surakshit Matritva Abhiyan, to improve maternal and neonatal health and decrease mortality. The various camps organised by the government and trust hospitals are doing wonders. Evolution is also tremendous; it is pocket friendly. I am not talking about it being cheaper, I mean you can literally carry it in your pocket, attach to your phone and do ultrasound. Ultrasound is not just a diagnostic modality, it’s a screening tool. It’s called screening tests when performed on healthy individuals. People get incidental findings when the disease has not progressed to cause discomfort and treated early decreasing morbidity and mortality and ultrasound plays a crucial role in it. The incidental findings are so much increased that we have a word for that “Incidentaloma”
Dr Akhilesh Mittal, Sr. Consultant & HOD, Radiology & Imaging, Accord Superspeciality Hospital also shares, “Ultrasound’s transformative role extends beyond individual patient care to have a profound impact on public health. The accessibility of ultrasound technology has facilitated widespread screening programs, enabling the early detection of diseases and contributing to preventive healthcare initiatives. This has proven particularly beneficial in addressing health disparities and improving health outcomes across diverse socio-economic strata.”
“In conclusion, the evolution of ultrasound in the Indian healthcare system, coupled with technological revolutions, AI integration, and the advent of portable devices, has not only transformed diagnostic imaging but has also elevated the standard of patient care. As ultrasound continues to shape the radiology landscape, its impact on public health underscores its significance as a key player in the ongoing healthcare revolution in the country”, he added.
Way forward
As technology continues to advance and healthcare infrastructure develops, ultrasound will play an increasingly crucial role in improving overall radiology landscape. By addressing challenges and embracing opportunities, the Indian healthcare system can ensure that ultrasound remains a cornerstone in providing accessible, affordable, and high-quality diagnostic services to diverse populations across the country.
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