ZONARE Medical Systems GmbH

The DKD relies on ultrasound technology from Zonare

Located in Wiesbaden, Germany, the Deutsche Klinik für Diagnostik (DKD) opened its doors in 1970. As a health care center that employs highly-qualified personnel, state-of-the-art medical technology and advanced diagnostic techniques, this hospital continues to receive nationwide, but also international recognition. In the field of medical imaging, the DKD specializes in diagnostic ultrasound in difficult cases, in many cases, critically ill patients.

Dr. Jörg A. Bönhof, a course leader on internal medicine for the German Society of Ultrasound in Medicine and the DKD’s leading expert on abdominal ultrasound, reports that the hospital was in need of an ultrasound system that could be put to use universally, both as a cart-based system and as a portable device. “Finding a portable solution that would provide us with exceptionally high image quality was what counted most for us. Here, high spatial, temporal and contrast resolution were our main objectives, as these aspects are responsible for delivering an extremely high quality image of the actual structures and shapes inside the human body,” Dr. Bönhof explains.

Zone Sonography the answer

When ZONARE first introduced its z.one ultrasound system to the German market, the DKD decided to purchase this system almost immediately. This device is based on a unique new technology called Zone Sonography that results in much more rapid image formation than conventional systems. “Here, ZONARE has developed an extremely interesting approach. Images are formed much more quickly by scanning not only in individual lines, but rather entire zones and then storing this data,” Dr. Bönhof explains.
“The system’s intelligent imaging algorythms convinced us immediately. Furthermore, the way in which the system executed the intensity of the signals, on the one hand, and the pixel brightness, on the other, turns out to be so successful that we are able to immediately visualize the regions of interest to us, even when making difficult diagnoses,” Bönhof adds.

Unlike in the past, with the z.one system, the speed of signal processing is no longer limited by the speed of sound, but rather only by the speed of the processor itself. Furthermore, because the system is based entirely on software, there are no limits to the advances and future developments that take place at the hardware level. Thanks to a newly-developed chip that is capable of storing the raw data from an entire zone, unsatisfactory images can be processed by simply optimizing the most important image parameters or the brightness later.

Hybrid system offers greater flexibility

In addition to imaging performance, the mobility of the hybrid system was yet another important aspect in the DKD’s decision to purchase this system. “We were very excited about being able to obtain so much performance from such a compact device, thanks to its advanced integrated electronics,” Dr. Bönhof notes. The portable, extremely light weight unit – the scan engine weighs only 2.5 kg – can be easily removed and taken to perform examinations at a patient’s bedside. This means there is no longer a need to push heavy and awkward systems through the hallways of buildings. In addition, because in many cases patients must be examined in emergency situations, this aspect is of great importance. Due to the many other apparatuses that are located next to the patient’s bed, there is hardly enough room for a cart-based ultrasound system. Finally, the concept of mobility also benefits the hospital in financial terms, because more examinations can be conducted now that less time is spent on transporting the system.

Triplex not a problem for the first time ever

Especially when he needs to work very quickly, Dr. Bönhof sees great advantages in being able to work in a triplex mode during Doppler examinations, in other words, being able to run B-mode, Color and Spectral Doppler all at the same time. “With conventional technologies, one normally needs to work with a frozen B-mode and color image. Because the z.one requires less time to acquire and form images, this is not the case and resultingly means good results are made available much more quickly,” Dr. Bönhof explains and adds: “Even with the normal B-mode image, there are far fewer movement artifacts. I will never forget being able to view extremely small local lesions in the liver very clearly.” His spectrum of typical examinations covers all of the abdominal organs, small parts, including lymph nodes, nerves, muscles, as well as arterial and venous blood vessels in the abdomen, the neck, arms and legs.

The speed of sound can be modified individually

Yet another features of the z.one that has truly impressed doctors at the DKD is the ability to adjust the speed of sound to suit each individual patient (Zone Speed
Technology). According to Dr. Bönhof, there are often situations in which the normal, standard setting (1,540 meters/second) “doesn’t work” and causes distortion in the images. “Here, the z.one adjusts the speed of sound at which ultrasound is transmitted at the press of a button to suit each individual patient and the surrounding examination conditions so that the images become visibly sharper, much like the way an autofocus works in today’s cameras. The deviation in the speed of sound is then displayed in the form of an index (ZSI Zone Speed Index) as part of the the image data,” he adds.

Due to the excellent experience that the DKD has had with the z.one, the hospital has already invested in yet another ZONARE unit that is now based in the wards. “We have also found the fact that the system was designed to suit our everyday work to be very positive. It is user-friendly and can be operated intuitively. This means very little time is needed to learn how to use it. With conventional technology, smaller devices are always inferior to much larger systems, however this does not apply to the z.one and its unique technology,“ Dr. Bönhof concludes.

Tissue with speeds of sound that vary from the usual calculated value of 1,540 m/s lead to defects in images with conventional technology.

Here, the speed of sound was determined to be 1,610 m/s (ZSI 70 means 1,540+70 m/s) at the press of a button with the z.one system, thus providing an accurate image that shows a recent rupture of the Achilles’ tendon with a diagnoal tear and bleeding.

Despite a parenchymatous change in the liver with a highly echogenic and minimally intense uneven echo pattern, this small hemangioma of the liver is easy to detect.

Even when viewing static objects, the z.one, with its high-performance imaging capabilities, is rather impressive. Here, a lumen in the urinary bladder is displayed free of artifacts. The various regions of the prostate can be identified, the wall of the rectum can be seen and the boundaries of the surrounding structures can be identified.

Obtaining a sharp image of moving organs is often very difficult. Here, being able to acquire images extremely quickly is of great benefit. Although the intestines have moved, the layers of the wall and the contents can be identified in this ultrasound image.

Dr. Jörg A. Bönhof, DKD Wiesbaden, Medical Imaging Techniques