Over the past ten years of teaching diagnostic ultrasound, one of the most common questions we get from delegates is what ‘ultrasound machine should I buy’, whether this is someone buying for a department, a clinic, sports club or as an individual.
If you read my blog on ’how to get started in diagnostic ultrasound’, you will see that you have to get good access to a machine to develop your skills! Otherwise it is like learning to play the guitar without access to a guitar! It just won’t happen! We would suggest at least two days a week you need access to a machine to make steady progress and acquire the skill… ideally more. If not, maybe you need to buy your own machine! A great investment IMO.
Good ultrasound machines are expensive and making the right decision is very important. So, take your time, ask the experts (independent ones) and carry out your own research.
Here are a few questions you need to ask yourself before you buy:
How much money do you have to spend?
The first most important one is how much money can you spend. It’s quite simple with ultrasound machines. Generally speaking, the more money you spend, the better the machine.
But also, and one aspect many don’t think about is…the more you spend initially the less likely you will want to upgrade the machine in 2-3 years. Often people buy a poor quality cheap machine or a handheld machine and want to upgrade their machine after 2-3 years. Buy cheap, buy twice! We always try and recommend people spend as much as they can as essentially you are making a long-term investment in your career.
Good ultrasound machines are not cheap! Although £5000 is a lot of money you will not get a very good machine at this price. As you get better at scanning you want to see more structures in greater detail, and you will require a better image. It is harder to scan on poorer quality machines. Ideally you need to spend approximately £10000 if you want a machine that will suffice for all areas of the body and will last for the next 5 – 10 years.
Ultrasound is highly operator and machine dependent imaging modality. Those delegates who have bought cheaper machines wanted to upgrade the machine after a few years. Quite simply, as you get better at scanning you want to see more. For example, the deeper structures around the hip, small nerves or proximal hamstring. So many wished they just bought a better machine and spent more money in the first place.
Buy cheap, buy twice!
|Case example: We recently had a physiotherapist on our course who had bought a cool new handheld machine called a Butterfly (see image). He saw the adverts on Facebook, thought it looked cool. It was relatively cheap (approximately £2000 I believe). Firstly, it does look very cool (like many of the handheld machines) but quite simply the Butterfly is not good enough for musculoskeletal scanning. Unfortunately, the marketing material and the sales reps are pushing it as a good option for musculoskeletal medicine. We would not recommend you buy it because you will soon be disappointed! For vascular and other scans, it maybe ok but not for musculoskeletal and sports injuries. The physio on the course had bought it a few weeks before our 2-day Introduction course and as soon as he started scanning on our machines, he was very disappointed with the image quality and immediately regretted the decision. In fact, at lunch time he tried to call Butterfly to get his money back|
Should you buy a second hand machines
On occasion you will find a reasonable machine for £5000-8000 second hand on Ebay or one of the re-sale sites. Be aware; you don’t know who you are buying from. We would always recommend you ‘try before you buy’. Second-hand machines on e-Bay are also very unlikely to have a warranty and if something goes wrong it can be very costly! Most machines are not repaired in the UK so would need to be posted somewhere in Europe. We are always happy for people to email us at SMUG if you are unsure about what machine to buy, would like our opinion on a machine or just want more advise.
Renting a machine – this would seem like a good idea but unfortunately not many manufacturers offer it. Many of the manufacturers do a ‘lease to buy option’ but they can work out fairly expensive. The only rental option we are aware of is the handheld machines such as the Sonon and Clarius machine. However, please read my article on ‘Should I buy a handheld machine’.
What will you be using it for?
This is a really important question and will affect what machine is appropriate for you. Ultrasound is being used by a variety of clinicians for many different reasons. If you want to use your machine for all musculoskeletal areas, then you need to aim for a high end machine with excellent image quality. However, if you will be using ultrasound to answer a more specific clinical question then a cheaper machine with a poorer image quality may suffice. A handheld machine may be adequate to answer the question. For example, if you want to look for an effusion in a hip joint, confirm an Achilles rupture or take measurements for a research study
What machine should you buy?
Prices are approximate INCLUDING VAT
|£10,000 to £15,000 (approximate)||£15,000 to £25,000 upwards (approximate)|
|GE V2||GE Logiq-e R7|
|Sonosite Edge 1||SamsungHM70A|
|Mindray M7||Konica Minolta Sonimage|
|Alpinion Ecube i7||Sonosite Edge 2|
|Sonosite M-Turbo||Alpinion Ecube i7|
The machines in the table above are those we have experience with. New machines are being introduced to the market all the time and there are many other good machines that we have not mentioned.
Portable machines between £15,000-£25,000 range (approximate)
The machines in this bracket are all good quality machines that are more than adequate for all MSK scanning. They all have the standard features you would expect at this level e.g high frequency probes, power Doppler, side to side comparison, needle visualisation etc…
On our SMUG courses we use Logiq-e R7 machines. These machines have excellent image quality and are one of the best portable options on the market. Many of our SMUG tutors use these machines in their clinic. Aswell as the image quality, the Logiq-e R7 is easy to use, has useful features such as the Logiq view (see below left) and easy side to side comparison (image below right). The image quality is also maintained at depths of around 4-6cm with the correct pre-sets. This is a sign of a good machine! SMUG delegates get an exclusive deal on the Loqiq-e R7. £14,999 plus VAT. This is excellent value for money.
Sonosite machines are probably the simplest machines to use and have simple functionality. They are also the most robust, as the probes themselves have a thick plastic casing which is ‘one-meter drop tested’ (they were designed to be used in the Armed Forces!). This is very reassuring if you travel a lot with your machine from clinic to clinic, considering most probes cost several thousands of pounds and are very delicate. The Sonosite machines are compact with a quick start up, very user friendly, and have good image quality. They come with all the standard options you would expect at this price – power Doppler, needle visualisation and easy recording and exporting functions. The screen is smaller than the GE which can be a negative to some people. Many beginners to ultrasound like the simplicity of the Sonosite machines.
The Samsung machine is a little more expensive but does have excellent image quality. It gives the Logiq-e R7 a run for its money! To choose between these two, you would have to assess them side by side before making a final decision. Both excellent portable machines. You will not be disappointed with either machine.
We have also test driven the Konica Minolta Sonimage on a few courses. This is a little more expensive but does have excellent image quality and a well presented easy to use touch screen. Worth a look if you have over £20,000 to spend.
Portable machines between £10,000-£15,000 range (approximate)
At this price range the image quality will not be as good as the more expensive machines, particularly at depths greater than 4 cm’s. The power Doppler can also be less sensitive. These machines are still more than adequate for musculoskeletal scanning and carrying out guided injections.
The GE V2 has all the functionality of the Logiq-e and is comparable in terms of image quality on superficial structures but on deeper structures and small nerves you will see a difference. If you can stretch to another £5000 to get the Logiq-e then it is worth the money. If not the V2 is a good starter.
I recently tried the Alpinion Ecube i7 which is relatively new to the UK market.. I was pleasantly surprised! It was easy to use, with good functionality and all the features you require for MSK imaging e.g. needle visualization, a sensitive power Doppler and easy side to side comparison. The image quality was very good and comparable to other machines at this price point. Worth a look.
Although it is an older machine now the Sonosite M-Turbo is still good value for money and still produces a good image. They are very portable, very robust and seem to last well. They also have a good battery life, which is a negative of the GE range. I have carried out thousands of guided injections on the Sonosite M-Turbo and have always be impressed by its performance despite its age! It can also be worth contacting the manufacturers as they sometimes have second hand/ex-demo machines that may be cheaper. Often these can come with a one-year warranty.
Portable machines under £10,000
This is where it can be very hit and miss. Any new machines under this price point I would always make sure you research it well. The main limitation will be the image quality compared to the other more expensive machines. I would always advise you try it out for a week or so and ideally compare them to other machines, so you know exactly what you are getting for your money. It’s simple a brand new machine for under £10,000 will perform like a brand new machine under £10,000. With ultrasound machines you get what you pay for. These machines would be good for scanning superficial structures but will lack the resolution of the more expensive machines.
We recently test drove the SonoScape and taught with them in Singapore and we were impressed with their image and functionality for their price. They have three machines less than £10,000. The E1 and E2 are their low-cost options and the image quality reflects this price point. If you are going to buy one, save for a few more months and get the X3! The X3 is around the 10K point including VAT and is a step up in terms of image quality from the E1 and E2.
Handheld devices are under £10,000 such as the Clarius/Athrex Synergy, Sonon 300 and Philips Lumify. For more information about these please read our blog ‘Should I buy a handheld device?’.
You may be able to get a second hand/ex-demo Sonosite M-turbo, an Edge 1 or a GE V2 for under £10,000. These are all good starter machines for MSK ultrasound.
Top Five Tips
1. Buy Cheap, buy twice! You get what you pay for. Bargains do not exist!
2. If you do buy cheap (less than £10,000) be aware that you are likely to want a new machine in 2-3 years
3. Do not buy a machine if you have not tried it. Try before you buy!
If you are a physiotherapist, sports doctor, GP or osteopath and have not scanned at all before, do not buy a machine until you have attended our Introduction course or gained some experience. This will give you an idea of what a good image looks like and avoid you buying a poor quality machine and wasting your money. If you have not scanned, you do not know what a good or bad machine are!
4. Think very carefully before you buy a handheld machine. Compare it to other machines and ensure it will be adequate for what you want to use it for. Also read my blog ‘Should I buy a handheld device?’.
5. Beware eBay buys or buying anything without a warranty! Do your research!
There are new machines coming out all the time and , obviously, it is is very difficult to keep up with all of them so please fee free to email me if you have any questions.
If you have no idea what to do, then please email me at email@example.com and ensure you spend wisely !!