The incredible shrinking ultrasound

Lisa Fratt, Editor

They say good things come in small packages. In the case of handheld ultrasound, which seems to be shrinking annually, the small package will diffuse ultrasound across the enterprise and across the globe.

Ultrasound systems have been shrinking in size and price, while demonstrating increasing clinical utility. Indeed, the era of the “stethoscope of the future,” in which ultrasound replaces the stethoscope, is approaching.

A recent report in the New England Journal of Medicine detailed the pros and cons of point-of-care ultrasound, pointing to its expanding role in screening, diagnosis and image-guided procedures. However, authors, Christopher L. Moore, MD, and Joshua A. Copel, MD, of the departments of emergency medicine and obstetrics, gynecology and reproductive sciences at Yale University School of Medicine in New Haven, Conn., referred to the growing use of point-of-care ultrasound among nonradiologists.

As ultrasound continues to shrink to smartphone size, it opens the door to new users and new applications. Uber portability, coupled with a low entry point, makes ultrasound an ideal diagnostic tool in the developing world. According to Moore and Copel, the World Health Organization has indicated that ultrasound, x-ray or a combination of both could meet two-thirds of the imaging needs of developing countries. Similarly, developed countries benefit from the same traits—as point-of-care ultrasound continues to demonstrate its utility and speed in a variety of emergent applications.

Improved access is a definite plus, but there’s a caveat. It’s becoming increasingly easy for nonradiologists to perform ultrasound studies, but quick exams might provide an incomplete answer and launch a cascade of downstream testing. Or, it may seem like the images suffice when a more robust test, such as a full-featured ultrasound scan, is required. And then there’s the issue of indication creep, where the test is performed for questionable indications because of its rapid and easy availability.

“In this era of trying to determine cost-effectiveness and look at the effect on patient outcomes for any test, we have to be a little circumspect about something that potentially could come with dramatic increase in usage of a particular test without any type of long-term study or analysis to indicate the effectiveness of increased usage of the test,” opined Jonathan W. Berlin, MD, MBA, clinical associate professor of radiology at the University of Chicago Pritzker School of Medicine.

The ever-shrinking package and price point is exciting and promising. However, as point-of-care ultrasound proliferates it does warrant a thoughtful approach with clear guidelines for use.

Lisa Fratt

lfratt@healthimaging.com