To the Editor:
We believe that expanded training in the use of ultrasound will lead to better health care for both individuals and populations. In the rest of this letter, we explain why we make this proposal.
Advances in medical imaging, including CT, MRI, and PET, have expanded the diagnostic capabilities of medicine in developed countries. However, overuse of these imaging modalities is straining modern health care systems. Ultrasound has also undergone dramatic advances in technology, resulting in pocket-sized ultrasound systems with great image quality. These small devices are used by clinicians at the point-of-care to obtain real-time clinical information, allowing near-instantaneous diagnosis and dramatically improving management and the monitoring of treatment.
Point-of-care ultrasound examinations are used to answer specific, typically binomial, clinical questions: Does the patient with trauma have intra-abdominal bleeding? Does the patient with a swollen leg have a DVT? Is the dyspnea due to heart or lung disease? Ultrasound can also be used to visually guide procedures in real time, such as central line placement, injections, and thoracentesis. The proved efficacy and the favorable benefit/risk ratio and benefit/cost ratio qualify this technology for widespread use throughout health care.
In addition, early studies have shown that ultrasound can also be an effective teaching tool in courses such as anatomy, physiology, physical diagnosis, and problem-based learning.1 Kobal et al2 demonstrated that two first-year medical students with 4 hours of lecture and 14 hours of hands-on training outperformed five board-certified cardiologists using stethoscopes in diagnosing cardiac pathology in 61 cardiac patients. The cardiologists identified 49% of the pathology; the students identified 75%.
Despite the clinical and educational advantages of ultrasound, a major limiting factor at present is the lack of adequately trained users. We believe that it is time to expand ultrasound education for practicing health care providers and to train the next generation; this could make a critical difference in the coming years. Health care educators must set adequate standards and develop evidence-based ultrasound curricula. Remaining questions about the clinical and educational value of ultrasound could be addressed through further research.
Richard Hoppmann, MD
Dean, professor of medicine, and director,
Ultrasound Institute, University of South Carolina
School of Medicine, Columbia, South Carolina.
Michael Blaivas, MD
Professor of emergency medicine and associate
professor of internal medicine, Northside Hospital
Forsyth, Atlanta, Georgia, vice president, Society of
Ultrasound in Medical Education, editor-in-chief,
Critical Ultrasound Journal, chair, AIUM Emergency
and Critical Care Ultrasound Section, and
subspecialty editor, Journal of Ultrasound in
Mahmoud Elbarbary, MD, PhD, MSc, EDIC
Consultant and assistant professor of critical care
medicine for health sciences, King Saud Bin
Abdulaziz University of Health Sciences, Riyadh,
1. Hoppmann RA, Rao VV, Poston MB, et al.. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011;3:1–12.
2. Kobal SL, Trento L, Baharami S, et al.. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005;96:1002–1006.