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... but the "magnitudes larger" that they are sold is also endogenous to the regulatory framework around them. Suppose you had to get a PhD in physics to be able to get a drivers license. All of a sudden we would see a lot fewer buying -- and therefore far fewer people selling -- cars since it is so expensive to actually be able to drive them.

With these ultrasounds, there is such a heavy regulatory framework at work -- from regulations impacting the device itself to regulations preventing hospitals from being built to regulations preventing hospitals from having as many of these as they want -- that they make the actual quantity demanded of these things artificially small. Your point about evolution of the technology also falls trap to this same fallacy: Again, if all of a sudden you are artificially making something much more expensive to produce, it should be no surprise to you that the refresh rate on the device would be smaller. Here you also have the added effect that since we rarely pay for our own medical care and instead rely on insurance, many of the incentives that would exist for companies to make cheaper, faster, better equipment also disappear. Lastly, I fully concede that it is quite possible that there is some basic, inherent quality of ultrasounds that make them more complicated than cars or any other pieces of tech. But that isn't important. The importance is realizing that the derivative of the state of these machines looks very different from other technology industries where competition and the free market are much more of a factor.

Ultrasound systems is probably the cheapest modality, there is quite a lot of competition in this market, there is a lot of innovations in this market, the machine are getting cheaper and more compact, and at least in the developed world there is no penury of ultrasound systems, the regulation are there to prevent somebody to build a shitty machine that for example burns you with and endoscopic probe (you would not like that), and the interpretation of ultrasound images requires to be highly trained (you won't even understand the basic physical features you have before your eyes if you are not trained, due to various artifacts that are intrinsical to the technology), which limit the potential for delivery machines to a significantly larger market, because all those machines would be of no use.

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