Typically, you think of ultrasound machines as devices used in hospital radiology laboratories to create images of the fetus in pregnant women or to pinpoint damage from heart attacks. One of the greatest advances in the fight against COVID-19 is the conversion of portable, battery-powered bedside ultrasound scanners to instantly show which organs are affected by the disease and to display digital images of the devastation to the heart, lungs or kidneys. These super-fast damage controls quickly follow the once slow path of COVID patients from the emergency room to the intensive care unit.
In the early days of the pandemic, hospitals relied on full-body CT or CAT scans that lasted an hour or more to determine if and where a patient might need life-saving treatments. "The patients died in the machine or in a resuscitation bay before we knew what the problems were," says Dr. Diku Mandavia, Chief Medical Officer at FUJIFILM Sonosite, the Japanese document processing and healthcare giant that is the world leader in point-of-care ultrasound equipment. "COVID-19 is so dangerous because it's a multi-organ disease. Point-of-care ultrasound is like a flashlight that is inserted into the body. The moment a flashlight needs to be turned on, you can see all organs and Monitor blood vessels. "
In early September, the FDA cleared Sonosite's devices to aid in diagnosing COVID-19 diseases. Today, unprecedented kilometers between emergency rooms and intensive care units are zipped from one newly admitted patient to the next on their devices. The pandemic has helped the scanners on wheels – also manufactured by competitors such as Philips and GE – become the fastest growing segment in the medical imaging industry. Dr. Mandavia, who likes to compare Sonosite devices to staples in your workshop toolbox, says, "When it comes to repairing COVID-19, they're the hospitals' Swiss army knife."
FujiFilm Sonosite PX ultrasound system. Courtesy FUJIFILM Sonosite
Today's Sonosite modules are about the size of an open laptop and weigh about ten pounds. They are usually mounted at chest height on a metal column attached to a four wheel stand. Some super-miniaturized models are hand-held, allowing a doctor to move the scanning needle with one fingering while reading the monitor held in the other hand. These compact units are a world apart from the first clumsy versions that Mandavia came across. After graduating from medical school in rural Canada, the young doctor took his first job in LA County + USA in the early 1990s. Medical center in downtown Los Angeles. "It was an urban battlefield, in some ways the same kind of battlefield we see for COVID," he recalls. “It was the height of the gang epidemic. We've had knives, shootings, car accidents. It was like a wartime MASH unit. “When patients arrived with internal bleeding, the only way to find out where the bleeding was coming from was to put them through a CAT scanner. The imaging took so long that the victims would die before doctors could determine the correct operation, which anticipates today's crisis.
At the time, ultrasound machines were huge, weighing about 300 pounds, and were limited to the radiology departments. "We tried moving them, but they were the size of a refrigerator," says Mandavia. To make matters worse, the probes broke every week and put the machines out of service for days. In 1999, L.A. County received the first compact device that could race through hospital corridors and deliver the fast imaging Mandavia wanted. The Sonosite 180 came from a Department of Defense grant to make a handheld ultrasound machine that is tough enough for use on the battlefield. The big breakthrough was the transition from analog to digital through the use of ASIC chips so that Sonosite could develop the first miniaturized, battery-operated device.
Mandavia saw great potential in expanding the use of scanners to diagnose a wide variety of life-threatening conditions. In the 2000s, he advised Sonosite on the development of new models and joined the manufacturer full-time as Chief Medical Officer in 2009. "We recognized the advantages of miniaturization and brought them to bed," he says. “You think of babies and radiology, but not of operating theaters or emergency services or working in helicopters. It made the units smaller and lowered the cost that brought them to so many other specialties. “This versatility would pay off in the COVID crisis.
Diku Mandavia, CMO of FujiFilm Sonosite. Courtesy FUJIFILM Sonosite
In 2012, Fujifilm bought Sonosite for $ 995 million. The deal marked a milestone in the Japanese giant's two-decade expansion in the US amounting to $ 9.5 billion. Fujifilm also made three major biologics contract manufacturing acquisitions. The company is currently manufacturing two drugs to fight COVID-19: a Novavax vaccine at its facilities in Texas and North Carolina and an Eli Lilly therapeutic, developed in partnership with the Gates Foundation, at its complex in Denmark . Overall, healthcare now accounts for $ 4.6 billion of Fujifilm's total sales of $ 21.2 billion.
The symbol, which is almost ninety years old, continues to have a strong presence in document processing and digital cameras. However, Fujifilm saw film breakdown early on and diversified into expanding areas like cosmetics and medical imaging. As a result, it now has robust growth and a market cap of $ 55 billion. The spontaneous reinvention contrasts sharply with the collapse of its one-time rival in the film, Eastman Kodak.
Mandavia first received a message from abroad about the effectiveness of the mobile units in fighting COVID. He got some of his intelligence on the COVID frontline as he still works part-time as an ambulance at LA County + USC. "If you look back in January and February, we had very little information in the US about how serious the disease was," he says. "In modern medicine we have rarely seen anything that is not in the textbooks and baffles the experts." With Sonosite devices abundant in hospitals around the world, Mandavia received reports of the initial targets of the outbreak. "We heard from doctors, first in China, then in Italy, that they were using point-of-care devices to map the lungs, heart and blood vessels of patients affected by COVID-19," he says.
The news from Milan, Ground Zero in Europe for the pandemic, which came to Mandavia via social media and emails from local doctors, underscored the newfound power of ultrasound. "Hundreds of COVID patients were admitted at the same time in hospitals in Milan," recalls Mandavia. "So you couldn't run them through CAT scanners." Instead, doctors and nurses improvised using a combination of ultrasound, which damages the organs, and pulse oximetry, which uses a sensor attached to a finger to measure the level of oxygen in the blood, in order to separate the seriously ill from the less ill.
"That told us we had a new use for the devices," says Mandavia. In the spring, orders for Sonosite machines increased, especially in Europe.
He notes that the widespread use of the portable units makes hospitals far safer for staff. "The constant transfer of patients from intensive care units to radiology means many journeys through the hallways where they can spread the virus, so doctors and nurses are at risk of developing COVID," he says. "With the portable devices, we can perform the scans directly at the bedside when the devices switch from ICU bed to ICU bed, so patients don't have to move nearly as much throughout the hospital." With the move to point-of-care imaging, CAT scanners are also released for important purposes such as identifying broken bones, tumors, or cancers. Every time a COVID patient goes through a CAT, hospital staff must spend 30 to 40 minutes cleaning the device to make sure it is virus-free. This requirement reduces the number of hours per day that patients are scanned and revenue is generated.
A COVID side effect that plagues hospitals: The administration of standard general anesthesia endangers the staff in the operating room, as an airway tube has to be passed over the patient's trachea for the process. Hospitals are reducing elective surgeries, where they make the most money out of fear that doctors and nurses will catch COVID in airway tube placement. Again, ultrasound offers a solution, the use of nerve blocks instead of general anesthesia. “The scanner looks through the skin and sees the nerves, so the anesthetist can determine exactly where to place the needle and inject the anesthetic around the nerve,” says Mandavia.
Mandavia describes the series of images that flash on the monitor during a COVID screening. "The devices show how well the heart pumps," he says. "They also signal kidney failure." A critical function is the marking of blood clots that regularly threaten the lives of COVID patients. "The monitor shows clots in the blood vessels and legs that go to the heart and can kill you and that need to be detected quickly," he adds. The pictures also show doctors exactly where to place the catheter that sends blood transfusions or drugs to the heart to prevent heart failure. "The catheter is like a plastic straw that goes down the throat and through the carotid artery into the heart," explains Mandavia. "With ultrasound, the doctor can determine exactly where the vein is and where the catheter should lead."
Mandavia warns that the resurgence in COVID cases signals that we are entering a scary new period. Hospitals need to increase capacity significantly to handle the huge increase. Tents can again be built in city parks to accommodate temporary emergency rooms and intensive care units. "When the wave hits, you can't drag a CAT scanner into a tent, but it's easy to use ultrasound machines at the treatment site that are lightweight and run on batteries," he says. The innovation that emerged from the violence of the gangs in LA is now fighting a new wave of murders that is as rapid and unpredictable as it is deadly. Fortunately, the new mobile weapon can also rush to every corner of a hospital overrun by COVID.
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