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Ultherapy Joule Settings: A Practical Energy-Safety Guide for 1.5–4.5 mm Depths

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Micro-focused ultrasound with visualization (MFU-V, Ultherapy) remains a core non-surgical tightening platform as global demand for face and neck lifting continues to grow. Recent clinical reviews report typical per-shot energy ranges of about 0.25–1.2 J, with most treatment parameters clustering between 0.3–0.9 J for facial indications. Within this band, energy increments from 0.15 J to about 1.05 J can be scaled safely when clinicians adjust for transducer depth (1.5, 3.0, 4.5 mm), anatomic site, patient tolerance, and total-line density, following manufacturer line patterns and regional regulatory guidance.

Against this backdrop, a structured understanding of the 0.15–1.05 J window across 1.5 mm, 3.0 mm, and 4.5 mm depths helps practitioners standardize protocols, train new operators, and optimize consumable usage without compromising patient safety. This article translates those Joule values into a practical, decision-grade framework for clinics standardizing Ultherapy protocols, managing workflows, and evaluating new vs certified pre-owned (CPO) Ulthera systems.

Core Principles of Ultherapy TCP Energy

The Ulthera System combines a control unit, DeepSEE handpiece, and interchangeable image/treat transducers that define the treatment depth, frequency, and scan length. Typical transducers include 1.5 mm (10 MHz), 3.0 mm (7 MHz), and 4.5 mm (4 or 7 MHz) modules, with scan lengths up to 25 mm.

Ultherapy uses micro-focused ultrasound bursts to create thermal coagulation points (TCPs)—discrete 1 mm³ lesions—placed in linear rows at fixed depths without disrupting the epidermis. Each burst of energy forms a line of TCPs, spaced at programmable intervals (commonly 1–1.5 mm) oriented along the treatment line. When discussing “0.15–1.05 J” in Ultherapy, the industry refers to the energy delivered per individual TCP, not per treatment line. This allows fine-grained scaling of dose intensity by depth, indication, and skin thickness, reaching targeted temperatures around 60–70°C in the focal zone to trigger neocollagenesis.

Technical and Operational Pain Points in Energy Scaling

A lack of clarity regarding shot-level energy vs line-level energy frequently creates clinical challenges. Many clinics do not clearly distinguish between shot-level energy (per TCP) and line-level energy (typically 17 TCPs over a 25 mm line). Without a shared language, senior practitioners might think in joules per line while junior operators look at device screens calibrated per TCP, producing inconsistent dosing across the practice.

Depth-specific tissue responses are also frequently underappreciated. At 4.5 mm, energy targets the SMAS and deep fibromuscular layers, where higher joule settings can be beneficial but carry a higher risk of discomfort and structural injury if overlapped excessively. At 1.5 mm, the epidermal and superficial dermal safety margin becomes critical. Running high-energy protocols on thin skin increases erythema, edema, or transient dysesthesia events.

Furthermore, when the supply of specific transducers becomes tight, some clinics react by shifting protocols toward doing more with fewer lines—escalating energy per TCP rather than maintaining proper line count and coverage. Escalating from 0.3 J to 1.0 J without adjusting spacing or passes provokes pain spikes and uneven outcomes.

Finally, documentation and training often lag behind protocol evolution. As newer Ultherapy PRIME systems expand clinical options, centers must constantly update their SOPs to match current clinical evidence, protecting the clinic against medico-legal risks during staff turnover.

MFU-V System Comparison and Energy Matrix

The following table provides a strategic clinical view comparing authentic Ultherapy/Ultherapy PRIME parameters against typical non-visualized HIFU devices and multi-brand hybrid platforms across core tissue depths.

Dimension Ultherapy / Ultherapy PRIME (MFU-V) Non-Visualized HIFU Face Devices Hybrid Energy Platforms
Depth Options 1.5 / 3.0 / 4.5 mm fixed focal depths Common 1.5 / 3.0 / 4.5 mm options 1.5–4.5 mm depending on system modules
Single TCP Energy Range Typical range 0.25–1.2 J; main protocols at 0.3–0.9 J Stated 0.1–2.0 J; practical usage 0.2–0.8 J Approximately 0.2–1.0 J based on indication
0.15–1.05 J Coverage Fully calibrated across complete clinical band Variable accuracy at extreme low/high ends Requires independent calibration per handpiece
Imaging & Visualization Real-time ultrasound visualization up to 8 mm No real-time imaging; relies on landmarks Basic B-mode or surface navigation only
Primary Utility Face/neck non-surgical lifting & wrinkle reduction Entry-level skin tightening and contouring Combined multi-modality lifting protocols
Consumable Ecosystem Genuine transducers & certified B2B supply pipelines OEM and aftermarket third-party variations Complex multi-brand tip inventory management
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Depth-Specific Energy Logic Across the 0.15–1.05 J Band

1.5 mm Depth: Superficial Dermis and Safety Margins

The 10 MHz 1.5 mm transducer targets the shallow dermal matrix and fine lines. Unit TCP energy typically ranges around 0.15–0.4 J to minimize epidermal thermal stress. In highly sensitive or thin-skin regions such as the periorbital zone, protocols often favor lower energies starting at 0.15–0.2 J, adjusting upward based on real-time tissue response and patient comfort. The system constrains absolute maximum output to under 1.5 J at this frequency to preserve superficial tissue safety.

3.0 mm Depth: The Dermal Reticular and Mid-Dermal Workhorse

Operating at 7 MHz, the 3.0 mm depth serves as the primary layer for skin tightening and structural collagen remodeling. TCP energies commonly span 0.25–0.8 J, balancing deep collagen targeting with manageable thermal loads. For mild-to-moderate laxity in the midface and jawline, standard protocols cluster between 0.3–0.6 J, paired with appropriate line density and line spacing to achieve gradual tissue contraction.

4.5 mm Depth: SMAS and Deep Musculoaponeurotic Targeting

The 4.5 mm depth utilizes 4 or 7 MHz frequencies to reach the deep SMAS layer and platysma. Energy settings scale between 0.4–1.05 J based on tissue thickness and anatomical location. High-end energies approaching 1.0–1.05 J are generally reserved for thicker submental and lower-face areas, where robust deep-layer thermal coagulation points are required. Operators utilize real-time imaging to confirm proper transducer coupling, avoiding underlying bone structure or major vascular pathways.

Actionable Energy and Line Prescription Examples

For the Jawline and Neck: Use a 4.5 mm transducer set to 0.6–0.9 J, delivering 17 TCPs per line. Apply lines along designated anatomical grids using a dual-layer, cross-hatched pattern to maximize tightening along the vector of laxity.

For the Mid and Lower Face: Utilize a 3.0 mm transducer set to 0.3–0.6 J, planning 4 to 6 horizontal rows per zone. Focus energy delivery directly on the tissue adjacent to the nasolabial folds and marionette lines to address gravity-induced descent.

For Periorbital and Fine Lines: Apply a 1.5 mm transducer set to 0.2–0.3 J. Reduce the structural line spacing slightly to target dense superficial wrinkling, while strictly avoiding overlapping lines in a triple-layer pattern.

Six Steps to Safely Scale Ultherapy Energy

Step 1: Define Clinical and Layer Targets Establish whether the primary treatment objective is deep structural lifting (SMAS), mid-dermal tightening (reticular dermis), or superficial texturing (upper dermis), assigning priority to the 4.5 mm, 3.0 mm, or 1.5 mm transducers respectively.

Step 2: Establish a Baseline Energy Value Begin new treatments or operator sessions using conservative mid-range parameters, such as 0.25–0.4 J depending on the selected depth. Evaluate initial patient feedback, immediate erythema, and transient localized edema within the first 1 to 2 lines before scaling upward.

Step 3: Grade Energy by Zone and Tissue Thickness Customize energy parameters across anatomical boundaries. Advance toward 0.75–1.0 J at the 4.5 mm depth in dense submental zones, while capping thinner zygomatic and periorbital fields to 0.15–0.4 J to protect delicate structures.

Step 4: Standardize Grid and Line Density Maintain fixed line parameters and grid configurations. Rely on incremental adjustments to single TCP energy rather than making ad-hoc additions to line counts, preventing localized heat accumulation.

Step 5: Record Three-Dimensional Patient Data Document patient profiles by tracking treatment zone, line count, and specific Joule settings (e.g., tracking tolerance at 0.3 J versus 0.6 J). This data forms an individualized map for multi-session maintenance plans.

Step 6: Coordinate Energy Strategy with Consumable Supply Align annual clinical volume forecasts with transducer procurement. Maintaining a reliable inventory of 1.5 mm, 3.0 mm, and 4.5 mm modules ensures the clinical team does not resort to inflating energy settings on an improper depth module due to a shortage of the correct transducer. Sourcing channels like ALLWILL assist clinics in establishing stable inventory cycles, bridging the gap between clinical protocol design and backend asset availability.

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Strategic Asset Management and Revenue Optimization

Ultherapy functions as a premium, non-surgical treatment that supports high revenue per session but requires precise resource scheduling to balance procedure times and consumable wear. The relationship between energy per TCP, line density, and total lines delivered directly governs treatment duration and transducer lifespan—the two primary components determining clinic return on investment (ROI).

Using standardized, mid-to-high energy lines maintains predictable patient outcomes and clinical value. Conversely, lowering energy to the bottom of the 0.15–1.05 J spectrum to maximize patient comfort can sometimes increase the necessity for follow-up sessions. This shifts the practice model toward a volume-driven approach, highlighting the value of system uptime and equipment longevity. In this environment, a thoroughly vetted Certified Pre-Owned (CPO) system can deliver performance metrics comparable to new hardware.

Biomedical Engineering Maintenance Checklist for Energy Consistency

To ensure the system delivers accurate acoustic energy across all depths, clinical engineering teams and device owners should utilize the following preventative maintenance checklist.

  • Verify Regulatory Markings and Lineage: Confirm device labeling and documentation align with applicable regional regulatory frameworks, such as FDA 510(k) clearances or CE marks. Maintain original Instructions for Use (IFU) and verified software versions to ensure calibrated energy delivery.

  • Inventory Transducer Lifecycle Data: Document all active 1.5 mm, 3.0 mm, and 4.5 mm transducers. Track serial numbers, manufacturing dates, and remaining shot capacities. For CPO hardware, require written logs of previous usage profiles.

  • Audit Calibration and Energy Limits: Confirm peak acoustic energy thresholds stay within manufacturer parameters, keeping maximum energy per pulse below 3 J for 4–7 MHz modules and under 1.5 J for 10 MHz modules. Establish periodic testing schedules to verify pulse timing.

  • Inspect Handpiece and Cabling Assemblies: Conduct weekly visual inspections of the DeepSEE handpiece and connected cables for signs of wear, insulation breakdown, or fluid ingress. Verify all integrated control buttons and emergency stop mechanisms respond immediately.

  • Validate Ultrasound Imaging Quality: Use a test phantom to confirm clear visualization up to the standard 8 mm depth. Ensure the B-mode image clearly differentiates tissue interfaces and bone boundaries without artifact interference.

  • Implement Environmental and Power Safeguards: Position the system within recommended temperature and humidity ranges to avoid thermal scanning shut-downs. Connect the console to an Uninterruptible Power Supply (UPS) to protect sensitive digital tracking components from power fluctuations.

  • Enforce Approved Cleaning Protocols: Disinfect transducer faces and handpiece surfaces according to manufacturer guidelines, avoiding abrasive chemicals or complete fluid immersion that could compromise acoustic membranes. Inspect membranes daily for micro-fissures.

  • Log Incidents and Calibrations: Keep a comprehensive service log detailing all preventative maintenance actions, part replacements, and clinical alerts to support quality assurance tracking across multi-site clinic networks.

Compliance, Safety, and Asset Procurement

The Ulthera System IFU stipulates that only properly trained medical professionals should operate the device. Improper handling can cause thermal burns, temporary motor or sensory nerve issues, or bruising. Side effects noted in clinical studies include transient erythema, mild edema, localized welting, and minor altered sensation, with most cases resolving within days or weeks.

From a compliance standpoint, energy delivery is contraindicated over the thyroid gland, major superficial blood vessels, and breast implants. Clinical safety parameters have not been established for pregnant patients or individuals with severe systemic diseases, requiring sound practitioner judgment.

When purchasing equipment, acquisition teams should avoid units with unverified service backgrounds or expired transducer sets. Sourcing through structured entities like ALLWILL offers access to comprehensive inspection logs, documented calibration cycles, and structured warranties, allowing clinics to confidently align asset acquisition with long-term clinical usage.

Operational Multi-Modality Scenarios

Scenario 1: Specialized Single-Clinic Optimization

Traditional Approach: Relying on legacy MFU hardware without imaging integration or distinct energy staging. Treatments are often delivered at a uniform face-wide setting of 0.3–0.4 J, leading to inconsistent lifting along the jawline. Integration Strategy: Deploying upgraded systems with real-time visualization alongside a stratified 0.3–0.9 J depth protocol. By stabilizing transducer acquisition channels through B2B partners like ALLWILL, the facility introduces advanced line-density protocols at a stable operating cost.

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Scenario 2: Multi-Site Corporate Standardization

Traditional Approach: Individual regional clinics operate under separate energy protocols based on local operator preference, resulting in non-standardized client data and variable outcomes across the brand. Integration Strategy: Corporate leadership introduces a centralized SOP covering the 0.15–1.05 J energy matrix across specified anatomical depths. This clinical standardization is paired with synchronized supply planning, allowing enterprise-level management of transducer consumption and consistent treatment outcomes.

Scenario 3: High-End Comprehensive Aesthetics Workflow

Traditional Approach: Skin tightening, surface laser retexturing, and deep tissue lifting operate as isolated services without a coordinated timeline, limiting patient outcomes to single-modality effects. Integration Strategy: The medical team builds an integrated annual program. The foundation relies on deep-layer Ultherapy 4.5 mm lifting (0.6–1.0 J), transitions to 3.0 mm mid-dermal targeting (0.3–0.6 J), and concludes with superficial RF or laser treatment. Consumable budgets across diverse platforms are managed through an all-inclusive supply partner, optimizing purchasing workflows.

Frequently Asked Questions

What is a safe starting point between 0.15 J and 1.05 J for facial treatments?

For most facial lifting protocols, a safe starting point involves setting the 3.0 mm transducer to 0.25–0.4 J, adjusting based on patient feedback. The 4.5 mm layer can be initiated at 0.4–0.6 J, while the 1.5 mm superficial transducer is typically kept at 0.15–0.3 J to protect the upper dermal boundaries.

How many thermal coagulation points are created per line, and how does that impact energy calculation?

A standard Ultherapy transducer delivers approximately 17 TCPs along a single 25 mm scan line. The total energy output per line represents the single TCP Joule setting multiplied by 17. Practitioners must manage both single-point Joule values and total line counts to prevent localized thermal cross-over.

What is the target temperature achieved within the 0.15–1.05 J range?

The system creates localized temperatures between 60–70°C at the designated focal depth, which is the optimal range to induce collagen denaturation and subsequent tissue synthesis without causing widespread coagulative necrosis, provided spacing parameters are followed.

How should an operator adjust energy when moving between 1.5 mm, 3.0 mm, and 4.5 mm transducers? 

The standard clinical approach uses higher-range energies (0.6–0.9 J) at the 4.5 mm depth to effectively target the dense fibromuscular layers of the SMAS and platysma. As the operator moves superficially to the 3.0 mm depth (the reticular dermis), energy should be systematically scaled down to a moderate range (0.3–0.6 J) to balance structural remodeling with manageable thermal accumulation. Finally, when switching to the 1.5 mm superficial transducer, the operator must lower parameters strictly to 0.15–0.3 J. This step-down logic ensures optimal acoustic power reaches deeper foundational layers while maintaining a stringent safety margin to prevent epidermal thermal stress or transient dysesthesia in shallow tissue boundaries.

Key Takeaways for Practice Managers

  • Standardize Device Metrics: Ensure your entire clinical team explicitly differentiates between single-point TCP energy and total line energy to prevent accidental over-dosing.

  • Prioritize Real-Time Visualization: Always utilize active ultrasound imaging to verify proper transducer coupling, map anatomical boundaries, and protect underlying bone and major vascular paths.

  • Maintain Balanced Inventories: Secure a reliable supply of all three core transducer depths (1.5 mm, 3.0 mm, and 4.5 mm) through verified B2B pipelines like ALLWILL to avoid clinical workarounds or unsafe energy inflation on incorrect modules.

  • Enforce Strict Preventative Maintenance: Adhere to a rigorous clinical engineering checklist—including weekly handpiece inspections, regular calibration audits, and ultrasound image validation—to secure consistent energy delivery and protect clinical ROI.

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(e) Notice and Inspection. The limited warranties contained in this Section 8 are made on condition that immediate written notice of any noncompliance with the Equipment’s and/or the Service’s warranty be given to MRP, and provided that MRP’s inspection reveals that Buyer’s claim is valid under the terms of such warranty.

        9.  DISCLAIMERS; NO OTHER WARRANTY. EXCEPT TO THE EXTENT AS PROVIDED IN SECTION 8(c)(i)(D), BUYER ACKNOWLEDGES THAT MRP IS NOT BOUND BY ANY WARRANTY THAT MAY BE SET FORTH IN A MANUFACTURER’S WRITTEN MATERIALS THAT WOULD HAVE APPLIED HAD BUYER PURCHASED THE EQUIPMENT DIRECTLY FROM THE MANUFACTURER IN ITS UNUSED STATE. BUYER ACKNOWLEDGES THAT BUYER HAS NOT RELIED UPON ANY WARRANTY OTHER THAN AS SET FORTH IN THIS AGREEMENT. IN ADDITION, BUYER ALSO HEREBY ACKNOWLEDGES AND AGREES THAT ANY ORAL OR WRITTEN STATEMENTS CONCERNING USE AND REGULATION OF MEDICAL DEVICES SOLD BY MRP ARE AND SHALL BE CONSTRUED AS FOR INFORMATIONAL PURPOSES ONLY AND WITHOUT WARRANTY OR ASSURANCE BY MRP AS TO THEIR ACCURACY OR VALIDITY. MRP ALSO HEREBY DISCLAIMS ANY AND ALL WARRANTIES REGARDING OTHER MEDICAL CARE OR HELP, INCLUDING THE SELECTION OF AESTHETIC AND MEDICAL PROCEDURES AND PRODUCTS FOR, OR CARE OF, PATIENTS. THE LIMITED WARRANTIES OF THIS AGREEMENT, IF APPLICABLE TO ANY EQUIPMENT OR SERVICE FURNISHED UNDER THIS AGREEMENT, CONSTITUTE THE ONLY WARRANTIES MADE WITH RESPECT TO THE EQUIPMENT AND/OR SERVICE AND ANY DEFECT, DEFICIENCY OR NONCONFORMITY. TO THE EXTENT PERMITTED BY LAW, SUCH WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED BY LAW, COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY, TITLE, NONINFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE.

        10.  LIMITATION OF LIABILITY. NOTWITHSTANDING ANYTHING TO THE CONTRARY IN THIS AGREEMENT, UNDER NO CIRCUMSTANCES SHALL MRP BE LIABLE FOR ANY INDIRECT, PUNITIVE, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY OR SPECIAL DAMAGES, ARISING FROM, RELATED TO OR CAUSED, DIRECTLY OR INDIRECTLY, WHETHER FORESEEABLE OR NOT, BY THE EQUIPMENT AND/OR THE SERVICES, THE USE OR INABILITY TO USE THE EQUIPMENT, THE RESULTS GENERATED FROM THE EQUIPMENT AND/OR THE SERVICES, THIS AGREEMENT, ANY OTHER ACT OR OMISSION OF MRP, OR BASED UPON ANY OTHER LEGAL THEORY. IN NO EVENT SHALL MRP BE LIABLE FOR ANY LOSSES OF REVENUE, USE, BUSINESS OPPORTUNITY, PROFIT, SAVINGS OR ANY OTHER DAMAGES DUE TO ANY CAUSE WHATSOEVER, EVEN IF MRP OR ITS AGENTS HAS BEEN ADVISED OF THE POSSIBILITY THEREOF. THE FOREGOING IS A SEPARATE, ESSENTIAL TERM OF THIS AGREEMENT, AND SHALL BE EFFECTIVE UPON THE FAILURE OF ANY REMEDY, EXCLUSIVE OR NOT. IN NO EVENT WILL MRP’S TOTAL LIABILITY UNDER THIS AGREEMENT EXCEED THE PURCHASE PRICE ACTUALLY PAID TO MRP BY BUYER FOR THE EQUIPMENT AND/OR THE SERVICES GIVING RISE TO THE CLAIM FOR WHICH DAMAGES ARE BEING SOUGHT. NO SUIT OR ACTION MAY BE BROUGHT BY BUYER, ITS SHAREHOLDERS, DIRECTORS, MANAGERS, EMPLOYEES OR AGENTS FOR ANY BREACH OF THIS AGREEMENT MORE THAN ONE (1) YEAR AFTER THE ACCRUAL OF SUCH CAUSE OF ACTION. IT IS AGREED THAT MRP’S LIABILITY IS SO LIMITED. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, BUYER ASSUMES ALL RISK AND LIABILITY FOR THE RESULTS OBTAINED BY THE USE OF ANY EQUIPMENT IN THE PRACTICE OF ANY PROCESS, WHETHER IN TERMS OF OPERATING COSTS, GENERAL EFFECTIVENESS, SUCCESS OR FAILURE, AND REGARDLESS OF ANY ORAL OR WRITTEN STATEMENTS MADE BY MRP, BY WAY OF TECHNICAL ADVICE OR OTHERWISE, RELATED TO THE USE OF THE EQUIPMENT.

        11.  BUYER’S REPRESENTATIONS AND WARRANTIES. Buyer represents and warrants to MRP that: (a) Buyer is duly organized, validly existing, and in good standing in the jurisdiction of Buyer’s formation; (b) Buyer is duly qualified to do business and is in good standing in every jurisdiction in which such qualification is required; (c) Buyer has the full right, power, and authority to enter into this Agreement and to perform Buyer’s obligations under this Agreement; (d) the execution of this Agreement by the person whose signature is set forth at the end hereof has been duly authorized by all necessary corporate action of Buyer; (e) when executed and delivered by each of MRP and Buyer, this Agreement will constitute the legal, valid and binding obligation of Buyer, enforceable against Buyer in accordance with its terms; (f) Buyer is in compliance with all applicable laws relating to this Agreement, the Equipment and the operation of Buyer’s business; (g) Buyer is not insolvent and is paying all of its debts as they become due; and (h) all financial information that Buyer has provided to MRP is true and accurate and fairly represents Buyer’s financial condition.

        12. PROPRIETARY RIGHTS.

(a) Ownership. No sale shall be construed as granting to Buyer any license or other right in, or to, any of MRP’s (i) patents; (ii) trademarks; (iii) internet domain names, whether or not trademarks, registered by any authorized private registrar or governmental authority, web addresses, web pages, websites and URLs; (iv) works of authorship, expressions, designs and design registrations, whether or not copyrightable, including copyrights and copyrightable works, software and firmware, technical data, data files, and databases and other specifications and documentation; (v) trade secrets; (vi) environmental or other testing applicable to the Equipment and/or the Services; and (vii) industrial and other intellectual property rights, and all rights, interests, and protections that are associated with, equivalent or similar to, or required for the exercise of, any of the foregoing, however arising, in each case whether registered or unregistered and including all registrations and applications for, and renewals or extensions of, such rights or forms of protection pursuant to the laws of any jurisdiction throughout in any part of the world (collectively, the “Intellectual Property Rights”).

(b) Prohibited Acts. Buyer shall not (i) take any action that might interfere with any of MRP’s rights in or to Intellectual Property Rights, including MRP’s ownership or exercise thereof; (ii) challenge any right, title, or interest of MRP in or to the Intellectual Property Rights; (iii) make any claim or take any action adverse to MRP’s ownership of the Intellectual Property Rights; (iv) register or apply for registrations, anywhere in the world, for MRP’s trademarks or any other trademark that is similar to MRP’s trademarks or that incorporates MRP’s trademarks in whole or in confusingly similar part; (v) use any mark, anywhere that is confusingly

similar to MRP’s trademarks in whole or in confusingly similar part; (vi) engage in any action that tends to disparage, dilute the value of or reflect negatively on the Equipment and/or the Services or any of MRP’s trademarks; (vii) misappropriate any of MRP’s trademarks for use as a domain name without prior written consent from MRP; or (viii) alter, obscure or remove any of MRP’s trademarks, or trademark or copyright notices or any other proprietary rights notices placed on the

Equipment, marketing materials or other materials that MRP may provide.

        13.  CONFIDENTIAL INFORMATION. Without the prior written consent of MRP,Buyer, directly or indirectly, shall not disclose (and will direct its directors, shareholders, employees and agents not to disclose) any Confidential Information. The term “Confidential Information” means any information of or relating to MRP or the Equipment and/or the Services not generally known to the public (other than as a result of disclosure in violation of this Agreement) in spoken, printed, electronic or any other form or medium, including, but not limited to, business processes, practices, methods, policies, plans, publications, documents, research, operations, services, strategies, techniques, agreements, contracts, transactions, potential transactions, know-how, trade secrets, databases, manuals, records, supplier information, financial information, accounting information, legal information, marketing information, pricing information, payroll information, personnel information, and supplier lists.

        14.  NON-SOLICITATION. Buyer agrees not to solicit or hire any personnel of MRP involved with the delivery of the Services during the provision of such Services and for twelve (12) months after the completion of such Services; provided, however, that Buyer may hire individuals employed by MRP who, without other solicitation, respond to advertisements or solicitations aimed at the general public.

        15.  EQUITABLE REMEDIES. Buyer acknowledges and agrees that (a) a breach or threatened breach by Buyer of any of its obligations under Sections 13 or 14 would give rise to irreparable harm to MRP for which monetary damages would not be an adequate remedy and (b) in the event of a breach or a threatened breach by Buyer of any such obligations, MRP shall, in addition to any and all other rights and remedies that may be available to MRP at law, at equity, or otherwise in respect of such breach, be entitled to equitable relief, including a temporary restraining order, an injunction, specific performance, and any other relief that may be available from a court of competent jurisdiction, without any requirement to post a bond or other security, and without any requirement to prove actual damages or that monetary damages will not afford an adequate remedy. Buyer agrees that Buyer will not oppose or otherwise challenge the appropriateness of equitable relief or the entry by a court of competent jurisdiction of an order granting equitable relief, in either case, consistent with the terms of this Section 15.

        16.  INDEMNIFICATION. Buyer agrees to indemnify, defend and hold harmless MRP and its directors, shareholders, employees and agents (collectively, “MRP Indemnitees”) against any liability, damage, loss or expense incurred by or imposed in connection with any claims, suits, actions, demands or judgments arising out of (a) any breach or non-fulfillment of any representation, warranty or covenant set forth in this Agreement by Buyer or its directors, managers, employees or agents (collectively, “Buyer’s Agents”); (b) any negligent act or omission or willful misconduct of Buyer or Buyer’s Agents in connection with this Agreement; (c) any bodily injury, death of any person or damage to real or tangible personal property caused by Buyer or Buyer’s Agents, including the use of unauthorized parts in or service of the Equipment; (d) any failure by Buyer or Buyer’s Agents to comply with any applicable laws; (e) any fraud or other intentional acts by Buyer or Buyer’s Agents; and (f) the use or operation of the Equipment, including, without limitation, any medical and/or surgical procedures performed by Buyer, and any of Buyer’s Agents, using the Equipment unless said damages are determined by a court of competence jurisdiction to be solely by the gross negligence of MRP or solely as result of a breach by MRP of the limited warranties contained herein.

        17.  DEFAULTS; REMEDIES. Notwithstanding anything herein to the contrary, should Buyer fail to pay for the order or any other amount, in whole or in part, when due or perform its other obligations under this Agreement or as otherwise mutually agreed in writing between Buyer and MRP (each, a “Default”), then MRP may take any and all actions available under law or equity to collect said amounts with a ten (10) day prior written notice, including, but not limited to, enforcing its security interest, accelerating the payment of and declaring immediately due and payable any unpaid balance of the order, referral to outside collection agencies and/or commencement of legal action. MRP’s rights shall be cumulative, and it shall not be required to have attempted to realize upon to the Equipment before taking any other collection actions. MRP may require that Buyer assemble and return any or all of the Equipment to MRP and, in the event Buyer fails to return such Equipment peaceably, enter upon the premises where such Equipment is located, with or without legal process, and repossess such Equipment. Upon a Default, Buyer agrees to pay upon MRP’s demand: (i) all costs and expenses incurred by MRP or its assignee in connection with the enforcement of any remedies, including all expenses incurred in connection with the return, sale, release or other disposition of the Equipment, including attorneys’ fees and other costs incurred by MRP or its assignee in enforcing or defending its rights and remedies under this Agreement and any other written agreement between Buyer and MRP.

        18.  COMPLIANCE WITH LAWS. Buyer shall (a) carry out the transactions contemplated by this sale and deal with the Equipment in conformity with all applicable laws, rules and regulations of all government authorities, including, without limitation, export laws, (b) obtain all permits and licenses required in connection with the purchase, shipment, installation or use of the Equipment, and (c) be solely responsible to fully understand and comply with laws, rules and regulations. Any information provided is as a convenience only.

        19.  FURTHER ASSURANCES. Upon MRP’s reasonable request, Buyer shall, at its sole cost and expense, execute and deliver all such further documents and instruments, and take all such further acts, necessary to give full effect to this Agreement.

        20.  ASSIGNMENT; SUCCESSORS AND ASSIGNS. Buyer cannot delegate any duties nor assign any rights or claims under this Agreement without MRP’s prior written consent, and any such attempt or assignment shall be void. In the event that Buyer finances its acquisition of any Equipment with a third party, Buyer may direct MRP to transfer title of such Equipment to such third-party financing company, with all remaining terms and conditions of this Agreement remaining in full force and effect. This Agreement is binding on and inures to the benefit of the parties to this Agreement and their respective permitted successors and permitted assigns.

        21.  NO THIRD-PARTY BENEFICIARIES. Subject to Section 16, this Agreement benefits solely the parties to this Agreement and their respective permitted successors and assigns, and nothing in this Agreement, express or implied, confers on any other person any legal or equitable right, benefit, or remedy of any nature whatsoever under or by reason of this Agreement.

        22.  GOVERNING LAW; VENUE. The application of the UN Convention on Contracts for the International Sale of Goods is expressly excluded. The parties agree that any and all claims, demands, disagreements, controversies or disputes arising out of or relating to this Agreement and any agreement or document delivered in connection herewith (collectively, “Claims”) shall be governed by and construed in accordance with the laws of the State of Utah and adjudicated exclusively in the state and federal courts located in or nearest to Summit County, Utah, which courts shall have the sole and exclusive jurisdiction and venue for adjudication of all Claims. The parties hereby agree upon, consent and stipulate to the jurisdiction and venue of the aforementioned courts for the adjudication of all Claims, to the exclusion of all other courts, forums and venues whatsoever.

        23.  NON-DISPARAGEMENT. Buyer shall not disparage MRP or MRP’s trademarks, websites, products or services, or display any such items in a derogatory or negative manner on any website or in any public forum or press release.

        24.  NOTICES. Any notice, demand, or communication required, permitted or desired to be given hereunder shall be deemed effectively given when personally delivered, when sent by electronic means, when received by overnight courier, or when mailed by prepaid, certified or registered mail, return receipt requested, addressed to the other party at its address set forth on the Quote or to such other address that the receiving party may designate from time to time in accordance with this Section 25.

        25.  PUBLIC ANNOUNCEMENTS. Unless otherwise stated herein, neither party shall issue a press release or otherwise advertise, make a public statement or disclose to any third-party information pertaining to the relationship arising under this Agreement, the existence or terms of this Agreement, the underlying transactions between MRP and Buyer or agent for Buyer or refer to the other party in relation to this Agreement without the other party’s prior written approval.

        26.  ENTIRE AGREEMENT; ADDITIONAL OR INCONSISTENT TERMS. Subject to Section 32, this Agreement constitutes the sole and entire agreement between the parties hereto relating to the subject matter hereof, and any unincorporated representation, affirmation of fact, course of prior dealings, promise or condition in connection therewith, or usage of the trade, shall not be binding on either party. Terms and conditions set forth which differ from, conflict with or are not included in this Agreement shall not be part of any agreement between MRP and Buyer unless both parties specifically accept such terms and conditions in writing.

        27.  WAIVER. No waiver under this Agreement is effective unless it is in writing and signed by the party waiving its right. Any waiver authorized on one occasion is effective only in that instance and only for the purpose stated and does not operate as a waiver on any future occasion. None of the following constitutes a waiver or estoppel of any right, remedy, power, privilege or condition arising from this Agreement: any failure or delay in exercising any right, remedy, power or privilege or in enforcing any condition under this Agreement; or any act, omission or course of dealing between the parties.

        28.  SURVIVAL. Subject to the limitations and other provisions of this Agreement, the representations and warranties of Buyer contained herein shall survive the expiration or earlier termination of this Agreement for a period of twelve (12) months after such expiration o termination and (b) this Section 29 and Sections 10, 12, 13, 14, 15, 16, 17, 21, 22, 23, 24, 26, and 32 of this Agreement, as well as any other provision that, in order to give proper effect to its intent, should survive such expiration or termination, shall survive the expiration or earlier termination of this Agreement. All other provisions of this Agreement shall not survive the expiration or earlier termination of this Agreement.

        29.  RELATIONSHIP OF PARTIES. Nothing in this Agreement creates any agency, joint venture, partnership or other form of joint enterprise, employment or fiduciary relationship between the parties. Neither party has any express or implied right or authority to assume or create any obligations on behalf of or in the name of the other party or to bind the other party to any contract, agreement or undertaking with any third party.

        30.  HEADINGS. The headings in this Agreement are for reference only and do not affect the interpretation of this Agreement.

        31.  ORDER OF PRECEDENCE. In the event of conflict between the Quote, a written agreement by MRP, and these Terms, the order of priority shall be: (1) the written

agreement by MRP, if only if executed by an MRP Officer, (2) the Quote and (3) these Terms, and only to the extent of the direct conflict. Notwithstanding the foregoing, MRP shall not be bound by, and specifically objects to, any terms, conditions or other provisions, both written and oral, which are different from, in addition to or inconsistent with the provisions of this Agreement which are set forth in any purchase order, receipt, acceptance, confirmation, correspondence or otherwise of, or by, Buyer. Fulfillment of Buyer’s order shall not constitute acceptance of any of Buyer’s terms and conditions and does not serve to modify or amend the terms and conditions contained herein.

        32.  SEVERABILITY. If any part of this Agreement is held to be void, illegal or unenforceable, then it shall be deemed to be severed from this Agreement and the remaining provisions shall continue in full force and effect; provided, however, that if any fundamental term or provision of this Agreement is held to be void, illegal or unenforceable, the remainder of this Agreement shall be unenforceable. Upon a determination that any term or provision is void, illegal or unenforceable, the parties shall negotiate in good faith to modify this Agreement to effect the original intent of the parties as closely as possible in order that the transactions contemplated hereby be consummated as originally contemplated to the greatest extent possible.