Technology & Services
The Clear Choice in Ultrasound
a report by
ALOKA Holding Europe AG
ALOKA continues to improve the high-end digital
product line by introducing the new top-level
ProSound SSD-5500-SV ultrasound scanner. The
combination of maximum imaging power with
extensive and versatile peripheral options consisting
of probes, integrated analysis workstation and
software make this device one of the leading
ultrasound scanners worldwide.
Japan-based ALOKA Co. Ltd. has traditionally taken
a role as pioneer in medical ultrasound research and
technology development over the past 50 years.
With a focus on diagnostic ultrasound products for
medical applications, ALOKA Co. Ltd. is committed
to continuously developing and offering best-in-class
solutions at the forefront of diagnostic and
quantitative ultrasound imaging.
Major technology breakthroughs such as the world’s
first commercial ultrasound device ever, convex
and phased array scanning, transeosophageal
echocardiography, three-dimensional ultrasound
technology and a DICOM-compatible full product
line have been launched and brought to market
since. Especially the introduction of Colour Doppler
technology in 1983 by ALOKA constituted a new
era in medical ultrasound diagnostics globally.
A full range of products and solutions is available to
be used in any clinical setting, from the private
practitioner’s office and small hospital departments to
the largest medical university and research institutes.
Besides the complete portfolio for general imaging,
abdominal and vascular applications, as well as for
combined (such as internal medicine) use, ALOKA
offers dedicated solutions for all specific requirements
of cardiology and cardiovascular users, covering the
full spectrum from neonatal and paediatric to adult
patient populations.
ProSound is not only a name for the ALOKA digital
scanner family: SSD-3500, SSD-4000, SSD-5000 and
SSD-5500; it is a synonym for a shared technological
platform that provides high-quality imaging to all
members of this family. All ProSound systems address
the user’s need for excellent system performance and
quality at different price levels. The systems are highly
BUSINESS BRIEFING: GLOBAL SURGERY 2003
modular and offer multiple upgrade options. Based on
technology of the top-level systems – SSD-5500 and
SSD-5000 – ALOKA equips its smaller system SSD-
4000 and even the SSD-3500 with the broadband 12-
bit beam-forming technology. This approved
technology utilises:
• Quint-Frequency-Imaging (QFI) multi-frequency
transmission;
• very wide dynamic range up to 182dB;
• 180° scan conversion on electronic probes; and
• up to 1,024 processing channels delivering
exceptional image quality.
It thereby handles 3,840 more steps of information
compared with conventional 10-bit devices and
samples this information at a speed of 320MHz. Even
the ‘smallest’ unit – the SSD-3500 – intended for an
out-patient department or private office benefits from
this technology and the wide range of available probes.
Surgery application of image guidance promotes safe
and effective management of a great range of surgical
procedures. Each available imaging modality
contributes to the safety and efficacy of selected
procedures. Methods such as endoscopy, computed
tomography, magnetic resonance imaging, ultrasound
and angiography all provide different information at
different levels of complexity. Perhaps ultrasound is
the least complicated because it can be used almost
anywhere at any time and at minimal cost.
ALOKA offers a wide variety of ‘surgical’ probes, i.e.
burr-hole and microsurgery probes for neurosurgery,
specially shaped intraoperative liver and laparoscopy
probes for abdominal surgery and others. Other
specialities include compatibility with Olympus
Endosonography (EUS) probes, as well as ALOKA
MicroTip (8F) mechanical-radial technology or
electronic 180°/360° mechanical transrectal scanning
– all integrated into one unit.
Contrast imaging using microbubbles has dramatically
improved vascular and organ visualisation. Ultrasound
contrast agents consist of microbubbles, which are the
most effective acoustic backscatters. The interaction
between the ultrasound beam and microbubbles is 1
 Technology & Services
Figure 1
Figure 2
very complex and has been an area of intense research
at ALOKA. Although echo enhancers had long been
under investigation, their clinical applications have
been limited to Doppler enhancement in difficult
cases. Only the advances in harmonic imaging and the
development of new contrast agents with flexible
shells stand to broaden the scope of ultrasound
diagnostic potential.
Harmonic imaging is based on the principle of
transmitting at frequency f and receiving at frequency
2f. The introduction of Pure Harmonic Detection
(PHD) technology into ALOKA systems was the
1. C J Harvey, M J Blomley, R J Eckersley and D O Cosgrove, “Developments in ultrasound contrast media”, Eur. Radiol.,
11(4) (2001), pp. 675–89, review.
2. D Becker, “Contrast enhanced ultrasound in the liver using low mechanical index—what is the difference?”, Ultraschall
2 Med., 23(6) (Dec. 2002), pp. 397–402.
basis for the contrast imaging improvements
following later. The PHD technology delivers superb
clear and crisp imaging in difficult patients, thereby
avoiding bulging of thin structures as seen in many
other implementations utilising so-called broadband
technology. Opposed to broadband PHD is a
narrow-band technology requiring a costly and very
precise control of transducer oscillation in order to
discard transmission of harmonic frequencies. As a
result, only truly tissue-generated harmonic signals
are employed for image generation.
The natural next step for ALOKA was to implement
analysis of phase-shift information for the detection
of contrast agents. The non-linear nature of
microbubble oscillation under the influence of sound
pressure generates phase-shifted signals that identify
the received harmonic signal as being originated by
the contrast agent and not the surrounding tissue.
This extended technology (ePHD) is specifically
tailored for contrast imaging and is available only on
the two top-level platforms SSD-5000 and SSD-
5500. The solution provided enables scanning with
an extremely low Mechanical Index (MI) of down to
0.03, maintaining very high sensitivity and delivering
a precise representation of contrast-perfused tissue,
even with high-frequency probes.
Contrast harmonic ultrasound images provide
patterns of high flow vasculature and overall
perfusion. Poor perfusion regions, including necrosis
or infarction, can be identified with contrast
harmonic ultrasound. The diagnostic improvements
achievable by contrast harmonic imaging are
impressing.1 “The detection rate for liver metastases
can be increased by approximately up to 40% with
this new technology. Correct sonographic
characterisation of liver tumors can be achieved in
nearly 100% more cases.”2
Cardiovascular systems of the ProSound family are
the SSD-4000, SSD-5000 and SSD-5500, with an
extensive range of sector and TEE probes for
cardiology as well as convex and linear transducers
for cardiovascular applications. Each of these systems
includes the currently fundamental echocardiography
toolsets to acquire and measure 2-D, M-mode,
spectral and colour flow Doppler registrations.
Further advanced features are available such as:
• a highly sensitive Tissue Doppler;
• realtime automated contour detection of
endocardial borders (A-SMA);
BUSINESS BRIEFING: GLOBAL SURGERY 2003
 The Clear Choice in Ultrasound

• Kinetic Imaging and realtime assessment of Figure 3

Ejection Fraction (CQ);

• realtime angle independent M-Mode (R-FAM –

Free Angular M-Mode);

• probe-dependant frame rates of more than 1,000

frames/sec;

• cardiac contrast imaging; and

• upcoming realtime 3-D imaging capabilities as a

future option.

Altogether, these and other options (i.e. Flow

Profile Analysis, IMP or TEI analysis, Stress Echo
and many more) allow for precise and early
diagnosis of heart disease.

Diagnoses of heart disease and heart failure in the

very early stages without clinical manifestations
have strongly become the focus of cardiac research.
All system tools in conjunction provide a very solid
basis, not only for daily routine, but go far beyond
by backing these research efforts extensively. Figure 4

Research has always been a pivotal concern at

ALOKA. The presence of R&D groups in Europe
and the US, collaborating closely with the core
group in Japan, enables specific local needs to be
addressed. Since the prevalence of diseases is
distributed globally inhomogeneously, each local
society has differing medical priorities. An example
is the different ratio of cardiac disease vs. stroke in
Western vs. Japanese societies. Other examples
would be rates of prostate or large intestine cancer
in Asia vs. Western countries, or, within Europe,
the differing prevalence of HCC. The goal of
ALOKA research is not only to provide the
necessary tools to manage diagnosis and treatment at
the current best level achievable, but to look ahead
and provide the future tools already today. The
implementation of the eTRACKING option into
the newly released SSD-5500-SV, as mentioned at
the beginning of the article, serves as an example for Technologically, eTRACKING is based on the
such effort. simultaneous and continuous realtime assessment of
changes of vessel diameter and blood flow velocity
The eTRACKING module is part of the system- during the heart cycle. The diameter change is
integrated eDMS analysis workstation, which monitored by tracking of the two vessel walls, and
provides various analysis and management tools: velocities are registered by Colour Doppler.
Distensibility is recorded with a temporal precession
• image and patient data management; of 1KHz and a spatial precession of λ/16 (λ =
• DICOM connectivity; wavelength). This means a precession of about
• Stress Echo analysis; 0.013mm at 7MHz, which is about ten times better
• Contrast Echo analysis; than conventional video-based systems offer, besides
• Tissue Doppler analysis; their inability to acquire such a high temporal
• Backscattered Energy Temporal Analysis (BETA); resolution. The recordings described are based on
• RAW-Data post-processing; and very special hardware and are available only with the
• eTRACKING. new flagship model: the SSD-5500-SV.

BUSINESS BRIEFING: GLOBAL SURGERY 2003

 Technology & Services
Figure 5
The combination of a standard ultrasound device
with the eTRACKING module permits assessment
of parameters describing:
• arterial stiffness;
• endothelial function;
• pulse wave speed;
• pulse wave energy; and
• ventriculoarterial coupling.
Standard cardiac and vascular assessments are
integrated seamlessly with new parameters widely
used in research settings nowadays.
There has been much recent interest in the
relationship between arterial properties and the
development of cardiovascular disease. Measurement
of, for example, arterial stiffness in epidemiological and
therapeutic studies has been firmly established and has
become both an important measure of cardiovascular
risk and a therapeutic target in its own right. Changes
in arterial properties cannot only be considered as a
marker of vascular ageing, but should also be seen as a
marker of future atherosclerotic disease.
In atherogenesis, Endothelial Dysfunction is the
earliest measurable functional abnormality of the
vessel wall. It is closely related to the risk factors of
atherosclerosis, to their intensity and duration. A
relation to cardiovascular events has been confirmed.
The association of increased cardiovascular risk with
risk factors including hypertension, diabetes mellitus,
hyperlipidemia, smoking and end-stage renal failure
has been understood. As changes can be detected
before the appearance of clinically apparent vascular
disease, and determination of arterial properties may
act as a marker for the development of individual
atherosclerotic disease and cardiac risk, the
framework that integrates these processes should not
be neglected. Vertriculoarterial interaction and the
underlying exchange of energy between systems
holds keys to understanding the function of the
whole system. Investigation of wave energy
propagation will aid this understanding.
In conclusion, arterial and vertriculoarterial
interaction properties are now recognised as being
important in predicting cardiovascular disease.
Assessment of these properties may, in the future,
even change procedures of diagnosing and treating
cardiovascular disease and create new therapeutic and
individual goals.
As the social environment changes, the role of
medical care is becoming increasingly important.
Against this background, ALOKA satisfies diverse
needs and enhanced medical care requirements by
supplying high-quality medical equipment.
ALOKA’s product range covers diagnostic
ultrasound systems – the major tool in image
diagnosis – as well as nuclear medicine diagnostic
systems, clinical laboratory systems and therapeutic
and surgical systems. All of its products target
enhanced performance and improved reliability and
are appreciated by customers worldwide.
ALOKA radiation-measuring instruments are used
extensively in a number of fields, including nuclear
power generation, medical care, biochemistry and
pharmacy, and play an important role in research and
examination. As a pioneer of radiation measurement,
the company has made a significant contribution to
the development of energy and isotope use.
ALOKA continues to emphasise the theme of
‘science and humanity’, with a view to improving
the future of medical care. ■
BUSINESS BRIEFING: GLOBAL SURGERY 2003