4D ICE: Kendall Waters Discusses the Next Billion Dollar Ultrasound Innovation

Welcome to this edition of MedTech Maestros, where we dive into the transformative advancements in ultrasound technology with Kendall Waters. From the cutting-edge potential of 4D Intracardiac Echocardiography (ICE) to the role of AI in reshaping diagnostic imaging, Kendall offers a forward-looking perspective on the future of ultrasound in cardiology and beyond.

The Journey of Kendall Waters: From Physics to Ultrasound Innovation

“I trained as a physicist... and got more into ultrasound physics."

Kendall Waters’ fascination with physics paved his path to ultrasound innovation. With a background in mathematical physics from his undergraduate and graduate studies, Kendall’s transition into medical ultrasound was serendipitous. A postdoctoral opportunity in France first exposed him to ultrasound’s potential in healthcare, igniting his interest.

Kendall started his career at Volcano, where he initially worked on intravascular ultrasound before expanding his focus to traditional ultrasound imaging at Siemens Healthineers. His leadership role at Enlight Medical marked a pivotal shift, focusing on ultrasound catheter technology. Spanning teams across the U.S. and China, Kendall’s leadership has driven a new era in ultrasound, especially in resource-limited startup environments.

Leading Innovation in a Startup Environment

“In startups, cash is king... we can do more with fewer top talent hires... for our first-generation product, we really want to leverage proven technologies where we can”

Kendall highlights the unique challenges faced by startups operating on a global scale, particularly in coordinating resources across different continents. Enlight Medical, being a Chinese company with significant operations in the US, exemplifies these challenges. The key to success lies in effective coordination of global resources and partnerships, which is essential for their image guidance projects. By relying on proven technologies for early-stage development, he reduces risks while fostering rapid innovation.

He highlights the significance of acquiring top talent to drive innovation efficiently, stating, "We can do more with fewer top talent hires," which helps the company innovate faster while maintaining cost-effectiveness.

The Future of Cardiology: 4D Intracardiac Echocardiography (ICE)

“2D ICE really came out of a company called ACUSON... 4D ICE has come on the market in recent years with major players like BWI and Philips,”

One of Kendall’s most exciting projects is the development of 4D Intracardiac Echocardiography (ICE). Traditionally limited to 2D imaging, ICE has made significant strides in recent years, and 4D ICE is set to revolutionize cardiology by providing real-time volumetric views of the heart.

Although 4D ICE is a relatively new imaging modality, Kendall believes its potential to improve procedural guidance during heart interventions is undeniable. By enhancing precision in cardiology, 4D ICE is poised to become a cornerstone of cardiovascular care.

Merging Ultrasound with Other Imaging Modalities

“What was kind of particular to me and our first major project related to image guidance is that to be successful, we really need partners and resources from around the world. So it's really a global effort,”

Kendall is a strong proponent of merging ultrasound with other imaging technologies when there is a meaningful benefit to clinical workflow. By integrating different modalities, clinicians can achieve far greater diagnostic precision.

One of the most promising applications Kendall discusses is the fusion of ultrasound with pre-intervention CT scans, which allows for better visualization and more effective procedures. He expects the medical imaging industry to improve on existing image fusion and co-registration technologies that combine ultrasound with other imaging and sensing modalities. CARTOSOUND is a good example of image fusion.  Philips Volcano SyncVision is an example of co-registering x-ray angio and IVUS. 

AI's Role in the Future of Ultrasound

“A lot of AI features today are trying to make it easier to acquire the right image, and then once the right image is acquired, automate some of the analysis,”

Kendall is particularly excited about the role of Artificial Intelligence (AI) in the evolution of ultrasound. AI is already transforming how ultrasound systems operate, making workflows more efficient by automating image acquisition and analysis.

While AI’s impact on image quality is still in its research stages, Kendall sees its potential to democratize ultrasound by automating tasks like image interpretation and optimization. This could make high-quality diagnostic tools more accessible to a broader range of clinicians, reshaping the way ultrasound is used in everyday medical practice.

Looking ahead, Kendall predicts that the ultrasound industry will continue to evolve, driven by the integration of AI and multi-modality approaches. Over the next decade, he foresees a significant shift toward more efficient, accurate, and accessible diagnostic tools, with ultrasound playing an increasingly central role in both diagnostic and interventional cardiology.

As we wrap up this edition, Kendall Waters' journey and insights provide a glimpse into the future of ultrasound technology. From 4D ICE to AI-driven diagnostics, the innovations on the horizon hold immense promise for cardiology and beyond.

Thank you for joining us on this journey through the world of ultrasound innovation with Kendall Waters.

Stay tuned for more insights from top innovators in the next edition of MedTech Maestros.