Ultrasound on the move

New York City internist John Postley is practicing the medicine of the future — at least as it's envisioned by one Bothell company.

The veteran physician, who describes himself as "chief of new toys" at his 22-doctor Madison Avenue practice, uses a SonoSite hand-carried ultrasound-imaging device to look inside his patients during routine physical exams.

He has used it to spot signs of kidney, thyroid and liver cancer, gallstones and, perhaps most significantly, cardiovascular disease, long before he would have detected them with the traditional touch-and-listen exam.

"If I take a poke at your abdomen, I don't know what's in there," said Postley, who started using SonoSite's devices five years ago. "And yet, all I've got to do is wave this non-radiation wand over your abdomen and I can see it."

Postley calls hand-carried ultrasound "the stethoscope of the 21st century."

That's music to the ears of SonoSite Chief Executive Kevin Goodwin, who sees his company's technology as more than just a replacement for traditional ultrasound systems — heavy, expensive machines typically found in a hospital's imaging department or a radiologist's office, and used frequently on pregnant women and heart patients.

By making ultrasound a versatile, portable tool, Goodwin said, "the long-term purpose of the company is to completely disrupt and change for the better the physical exam."

SonoSite projects the market for hand-carried ultrasound will more than quadruple to $1 billion by 2010. Half of that market, it says, could come from doctors performing an "imaging physical."

Postley is one of only a few doctors regularly using the $40,000 device for that purpose now. SonoSite knows of no primary-care or internal-medicine doctors in the Northwest doing likewise.

Eli Kammerman, an analyst with Cathay Financial, said he hasn't seen many medical-device markets expand that quickly. "I wouldn't be quite that optimistic," he said, "although I'm very positive on the market potential for these devices."

He expects the hand-carried ultrasound market to reach as much as $700 million by 2010.

SonoSite has aggressive projections for its own growth, as well. Goodwin said 2005 revenue is expected to be $147 million to $151 million, twice that of 2002. "We're hoping to double the business again three years out," he said.

SonoSite had its first full-year profit in 2004, nearly $3.7 million, not including a one-time tax benefit. Results for 2005 haven't been reported yet.

The company was spun out of ATL Ultrasound in 1998 to develop and market hand-carried ultrasound. ATL was one of the pioneers of diagnostic ultrasound, capitalizing on research into sonar at the University of Washington's Applied Physics Laboratory.

Goodwin said 2005 was the company's best year: SonoSite launched its third-generation product in June, shipped its 25,000th ultrasound device this fall and hit an all-time high of $38.66 a share in early December.

To foster uptake of its technology as part of the physical exam, SonoSite is focusing on the benefits of ultrasound in diagnosing and managing the No. 1 killer in the U.S., cardiovascular disease. That's where Postley has seen the most success with the device.

Doctors traditionally estimate risk of heart disease in patients without symptoms using a formula based on age, gender, smoking history, diabetes, cholesterol and blood pressure. But the Framingham Heart Study, as this method is called, misses many patients who are at risk and over-diagnoses others who have nothing to worry about.

"We've been looking for a long time at different ways of identifying people with a greater degree of sensitivity," Postley said.

The hand-carried ultrasound's high-resolution image and light weight (the latest model is about 8 pounds) allow him to accurately measure the thickness of the inner layers of a patient's carotid artery wall during an office visit. Postley said that is a more accurate predictor of cardiovascular-disease risk than current methods.

A 525-patient clinical study launched this fall by SonoSite could provide proof that ultrasound can spot early signs of heart disease. That would help persuade insurers to pay for screenings whose cost Postley puts at around $200.

"Eventually, payers will say, 'We've got to pay for this somehow, because it's better medicine,'" said Goodwin.

Insurance coverage, in turn, would help persuade more doctors to learn how to use the handheld devices.

Dr. Catherine Otto, director of the cardiology fellowship program at the University of Washington Medical Center, said the big questions are who should be using hand-carried ultrasound and what kind of training they will need.

"The ultrasound is still very dependent on the person" using the device, said Otto, who has SonoSite's latest model, the MicroMaxx, and has been using ultrasounds for 25 years. Many cardiologists are concerned "that people who are not adequately trained or experienced will use the technology and get incorrect answers," she said.

It may be easier to train students on the technology rather than persuading practicing doctors to change their ways, said Dr. Chris Kent, a UW anesthesiologist. He says using handheld ultrasound to guide insertion of needles and catheters "adds an extra dimension of safety" and makes his work more efficient "because you know exactly where your anesthetic is going."

Anesthesia is one of a dozen new markets for ultrasound. SonoSite derives 80 percent of its revenue from such emerging markets, which also include emergency medicine, surgery and pulmonology. The rest comes from traditional markets such as radiology and obstetrics.

SonoSite's success has attracted the attention of old-school ultrasound makers like General Electric, Philips (which bought ATL) and Siemens. Siemens Medical's Issaquah facility headquarters was moved to Mountain View, Calif., in 2000. Goodwin said the "big boys" of medical imaging once scoffed at the idea of a laptop-sized device cutting in on their market, but that's changed.

GE entered the category in 2002 and has been growing, he said, but is focused on the traditional ultrasound markets rather than the emerging applications SonoSite targets.

Benjamin J. Romano: 206-464-2149 or bromano@seattletimes.com

Information in this article, originally published January 5, 2006, was corrected January 8, 2006. In a previous version of this story, Siemens Medical's Issaquah facility was described as its headquarters for ultrasound products. The headquarters was moved to Mountain View, Calif., in 2000.