Common Probe Failures

Part Number 11007 Revision A
Sonora Medical Systems
ECO 06-0077
Common Ultrasound Probe Failures

G. Wayne Moore, B.Sc., MA
From the Transducer Analysis and Repair Laboratory,

Sonic Technology Laboratories,
Sonora Medical Systems, Longmont, Colorado USA
Correspondence: G. Wayne Moore, Sonora Medical Systems,
1751 South Fordham Street, Suite 100, Longmont, CO 80503 USA
E-mail: [email protected]
Copyright 2006
All Rights Reserved No portion of this document may be reproduced without written permission from Sonora Medical Systems
ECO 06-0077
INTRODUCTION
The proper care and regular testing of probes substantially influence the level of operating
expenses related to the ultrasound systems in your department. In fact experience has shown that
more than 70% of ultrasound service calls are in some fashion probe related. Published studies
have also shown that improperly functioning probes can materially impact the results of the
ultrasound examination. Probe failures, when discovered early enough, can more often than not
be repaired, potentially saving the department tens-of-thousands of dollars per year in operating
expense. This paper is designed to present the Sonographer with examples of common probe
problems and how to spot them in a timely manner, while effective repairs can still be made.
Further, suggestions are presented concerning what steps a Sonographer may take to insure
optimal performance from the probe as well as obtaining the longest effective use of the product.
While it is clear that everyone involved with the maintenance of the ultrasound devices in your
department is responsible for providing the patient with a safe and efficacious study, the lead for
ensuring this falls to the Sonographer, the professional who handles the probes on a daily basis.
The Sonographer, by virtue of their work is the first to spot any changes in the ultrasound image,
feel any slight electrical tingles from the probe, see any holes in the lens, cracks in the case or
tears in the cable. Any of these signs of failure should be reported to the Hospital Biomedical
Engineer or Clinical Engineer as soon as they are discovered. Additional ultrasound QA
documents are available to Sonographers and Biomedical Engineers free of charge from Sonora
Medical Systems.
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A Suggested Probe Inspection Routine

Inspecting The Transducer (Probe)
Cracks on the handle

Cracks on the nose piece
Cuts or gouges on the lens material
Swelling of the lens material
Condition of the bend relief(s)
Cracks or other signs of damage to the connector
Bent or damaged pins in the probe connector
If using a pin-less connector (e.g., Siemens/Acuson Sequoia probes) inspect the surface
of the connector to insure it is clean
Integrity and flexibility of the cable
Bite marks on the bending rubber (TEE probes)
What Can Hurt a Transducer?
Gels that have perfume or other molecular changing substances

Electro-static discharge on or around the lens of the probe, or the pins on the probe
connector
Rapid deceleration trauma (dropping the probe), or other blunt force trauma
Using the wrong sterilizing agents, or using the correct ones in the wrong manner
Improper storage
Not freezing the image before removing or connecting a probe to the system
Improper or insufficient cleaning, or cleaning with wrong substance (e.g. alcohol-based
wipes on the lens tends to dry the lens and make it detach from the probe)
Not using bite guards when performing a TEE examination
What Preventative Measures Can I take?
Inspect the probe on a daily basis use a magnifying glass to inspect the lens
Follow the recommendations for use and cleaning in the probe manual
Have the probe tested on a six-month basis, or if a problem is suspected
Keep transducer cables off the floor
Use the system probe holders when probe is not in use
What Else Should I Be Doing?
Electrical leakage testing as recommended by the Original Equipment Manufacturer

Involve your hospital Biomedical Engineer in regularly testing the probe elements
Establish with your Biomedical Engineering Department a comprehensive ultrasound QA
program that includes not only the probes, but the ultrasound system as well
If you suspect a probe is compromised in some manner, dont use it until it is tested.
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Common Probe Failures
Array housing separating from the seam normally

occurs when the probe has been in use for some
time, or if there is a manufacturing defect. Many
OEMs use glue in the manufacturing process to seal
the cap of the array housing to the body of the
probe. This glue can deteriorate as a function of
time as well as to exposure to cleaning agents. This
probe should not be used as it may present an
electrical shock hazard to the patient and the
sonographer. Further, if cleaning agents get inside
the probe they will normally destroy the array. This
type of failure can be repaired if caught early.
Seam line separating from nose cone becoming the

site of fluid infiltration. Less obvious than the
example above, this is the beginning of the cap
detachment. The compromise of the seam can be
seen with the aide of a small magnifying glass. If the
problem is found at this stage, the probe is easily
repairable.
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Lens Problems
Lens separating from housing
Multiple holes in the lens
Hole in Lens
Swollen Lens
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Various Structural Defects
Bent pins in the connector
Dents in connector housing
Dirty pin-less connector
Crack in Lens Cap
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TEE Problems
Broken seal near head of TEE probe
Contaminated bending rubber
Scratch on TEE lens
Holes in bending rubber
Stained bending rubber with hole
Bite Mark in Bending Rubber
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Cable Problems
Cable pulled out from under strain relief
Strain relief pulling away from array housing
Cable pulled away from strain relief
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Tears and Scratches
Cable Tear
Strain Relief Tear
TEE Array Housing Scratches
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TEE Re-coat and Re-Label
Before Re-label
After Re-label
One of the more common needs for repair on a TE probe is to re-coat and re-label the depth
markers. These marks fade as a function of use and through the disinfecting process. After the
Sonora re-coat and re-label process the TE probe is fully restored to its original condition.
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Testing for Dead Elements
Sonora FirstCall Test Report Each crystal within the array is tested
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Dead Elements
Sensitivity
1
Volts p-p
0.8
0.6
0.4
0.2
0
1
11
21
31
41
51
61
71
81
91
101
111
121
Elements
The Sonora FirstCall test is definitive in testing for dead

elements versus some problem with the system, or some
problem with the probe (e.g., bad connector pins, tear in cable
or delaminated lens). Although apparent that something is
wrong in the image above, studies have shown that as few as
two dead elements can distort Doppler signals resulting in
underestimation of velocity and increases in spectral broadening1.
1
(reference publication The Methods and Effects of Transducer Degradation on Image Quality, Beate, et al, Journal of SDMS 2003)
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ECO 06-0077
Dead elements appear to be relatively common in probes in clinical use with various
published data showing that 20 to 30% of probes in use having some form of clinically relevant
performance problem. The Table below was part of a recent ultrasound quality assurance
presentation given at the American Association of Physicists in Medicine and demonstrates the
high percentage of probes found in clinical use with dead elements. The probes were tested with
the Sonora FirstCall probe tester.
57 Probes from the UW-Hospital

Department of Radiology were tested
Scanner
# of probes
tested
>2 bad
elements
>5 bad
elements
ACUSON Sequoia
(2 systems)
18
ATL HDI 5000

(3 systems)
18
Philips iU-22
(4 systems)
15
GE Logic 9
Courtesy of Dr. James Zagzebski, University of Wisconsin - Madison
Copyright 2006
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Counterfeit Probes
Another concern for ultrasound departments has been the illegal introduction of both counterfeit
and misbranded probes into the after market. These probes are made to appear like they are built
by the Original Equipment Manufacturer (OEM), but have identifying marks that an observant
sonographer can spot. As shown above the two probes are very similar in appearance. The probe
on the left is the counterfeit as is distinguished by the different font color in the number 4, as well
as the absence of the name of the manufacturer, in this case Acuson. There is a potential safety
concern if using this probe relative to both the level of acoustic power being transmitted by the
counterfeit as well as electrical leakage and material biocompatibility. If the hospital has a
FirstCall probe-testing device, it will also reveal performance variance between the counterfeit
probe and an actual OEM probe.
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Detailed Testing and Use/Dont Use Example
The flow chart shown below indicates when to call in the Biomedical or Clinical Engineer to
execute a detailed test of a suspected transducer. The branching points are all binary (yes or no,
pass or fail, etc.).
Transducer testing begins with a visual inspection of the probe contact or wear-surface. As the
name implies, frequent use can wear or damage this surface, permitting caustic fluids, gels, or
microorganisms admittance to the inner portions of the transducer. A simple magnifying glass is
needed for this inspection.
- L e ns C u t or S c ratc he d
- H o le in Le n s
(C h ec k w ith M ag n ifying G las s)
- C ra ck in H o u sing
- T e a r in S tra in R elie f
- C u t in C a b le
- M is sing or B ro ke n P ins
in C o nn ec to r
- P rob e D ro pp e d
- Im ag e or D o pp le r P rob le m
- N ee dle P u nc ture
P ro be F a ilure
S us pe cte d or P o st
B iop s y P ro ce d ure
O b viou s
P hys ic al
D a m a ge ?
P hys ic a lly
E xa m ine P ro b e
YES
In form B io m e dica l
E ng in e er fo r
S a fety T e stin g
NO
NO
O th e rw ise ,
G o o d P ro b e
E va lu a te P ro b e
fo r R ep a ir o r
R e p la ce m e n t
PASS
In form B io m e dica l
E ng in e er fo r
F irstC all T es tin g
If D ro p p e d ,
C a ll fo r S e rv ic e
F A IL
F irstC a ll T es tin g
E le m e nt
D am a g e?
YES
U s e W ith C a u tio n
S ID E O F
ARRAY
<3
C o ns ec utive
D ea d?
3+
C o ns ec u tive
D ea d ?
Lo ca tion of
D ea d
E lem e nts ?
4+
C o ns ec u tive
W ea k?
CENTER OF
ARRAY
R ep lac e P ro b e
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Conclusion
The transducer is the most sensitive and most often damaged link in the ultrasound image
quality chain. Because the sonographer or physician handles the transducer during the ultrasound
examination, it is susceptible to all manner of physical damage resulting from accidental
dropping, aggressive cleaning methods, or other traumatic occurrences such as banging. Many
antiseptic solutions, and even seemingly innocuous perfumed coupling gels, can have a
negative long-term impact on both the acoustic lens bonding of a transducer, which can cause
either lens de-lamination or material decomposition, and affect the actual molecular composition
of the lens itself, resulting in a change in its acoustic transmission and reception characteristics.
The end result of either occurrence is a shorter transducer life. In our experience, high-use
ultrasound transducers often display some form of performance compromising anomaly within 18
to 24 months after being placed into service. During the ten-year (120 months) operational life
span of a premium quality ultrasound system, a transducer could potentially be replaced up to five
times, simply due to normal use. At an average cost of ~ $10,000 per transducer, the financial
impact of replacing transducers to the hospital or clinic becomes quite apparent.
An active and comprehensive ultrasound EBQA (evidence-based quality assurance)
program can substantially lower costs for hospitals by identifying probes early enough in the
failure process that they can be repaired rather than replaced. For example, a new transesophageal
(TE) probe can cost as much as $40,000 or more and a replacement (meaning the damaged one is
exchanged for another one) TE probe normally costs as much as $24,000 from the OEM. If the
TE probe is damaged and the damage discovered in time so that it is repairable, the repair cost is
normally 25% or less than the cost of replacement, or $6,000. Over the ten-year lifespan of the
ultrasound system in this scenario it would mean the difference between $120,000 in replacement
costs versus $30,000 in repair costs, or a difference of $90,000 for one probe alone. That $90,000
comes directly off the bottom-line of the hospitals profit. For a hospital operating on a 4%
margin that would mean an additional $2,250,000 of top-line billings would have been required to
generate that $90,000. And that is for one probe. Typically a hospital with a cardiac surgical
service would have multiple TE probes thereby compounding the financial impact.
Copyright 2006
ECO 06-0077
About Sonora Medical Systems

The dramatic cost containment health care environment in the United States, coupled with the
rapid industry consolidation into the hand of three major companies (General Electric, Philips and
Siemens) has put tremendous pressure on hospitals to seek new and innovative ways to not only
maintain profitability, but to survive. It is the driving purpose of Sonora to provide hospitals with
a comprehensive portfolio of after market products and services designed to allow our customers
to dramatically reduce the costs associated with managing and maintaining their diagnostic
imaging capital assets for longer periods of time, and in many cases obviating the need for
expensive OEM service contracts. From service training, to parts and industry leading advanced
probe repair, Sonora provides a turnkey cost-effective solution for the hospital contemplating
maintenance of its own ultrasound systems and probes. Sonoras team members have a combined
200 + years of experience in diagnostic imaging to put to use for our valued customers. Sonora is
an active member of NEMA (National Electrical Manufacturers Association) Ultrasound
Section (www.nema.org), is ISO9001 and ISO 13485 certified to the Medical Device Directive,
and has established probe repair facilities in cooperation with international partners in seven
countries around the world. Sonora has been voted in the Top Ten of the Readers Choice Awards
and is cited in the DotMed Top 100 Medical Companies.
At Sonora we test and repair more than 3,500 probes per year, saving the health care system in the
United States alone more than $25 million per year in unnecessary probe replacement costs. For
more information on our probe repair, and other after-marker services go to www.4sonora.com,
or call us at 303.682.5871. We look forward to serving you.
Copyright 2006
ECO 06-0077

1751 South Fordham Street, Suite 100
Longmont, Colorado 80503
303.682.5871
303.682.5915 Fax
www.4sonora.com
[email protected]
Copyright 2006

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Part Number 11007 Revision A

Sonora Medical Systems

Common Ultrasound Probe Failures

From the Transducer Analysis and Repair Laboratory,

Part Number 11007 Revision A

Sonora Medical Systems

Part Number 11007 Revision A

Sonora Medical Systems

A Suggested Probe Inspection Routine

Cracks on the handle

What Can Hurt a Transducer?

Gels that have perfume or other molecular changing substances

What Preventative Measures Can I take?

What Else Should I Be Doing?

Electrical leakage testing as recommended by the Original Equipment Manufacturer

Part Number 11007 Revision A

Sonora Medical Systems