Bedside Ultrasound Becoming Routine

According to a new report, that day has come.

The article published February 24, 2011, in the New England Journal of Medicine (NEJM) and authored by Yale School of Medicine (New Haven, CT, USA) clinicians Christopher L. Moore, MD, and Joshua A. Copel, MD, outlined how ultrasound use has moved beyond conventional specialties like radiology and is now being typically employed by clinicians across numerous medical specialties and practice arenas. From anesthesia to vascular surgery, Dr. Moore and Dr. Copel reported that, the use of ultrasond has increased across the board, with the biggest growth seen among nonradiologists.

Over the past 20 years, the equipment utilized in ultrasonography--a safe, effective, and noninvasive form of imaging that helps in diagnosis and guides procedures--has become more compact, higher quality and less costly, leading to the growth of point-of-care ultrasonography, which is performed and interpreted by the clinician at the bedside.

"Ideally, point-of-care ultrasonography can decrease medical errors, provide more real-time diagnosis, and supplement or replace more advanced imaging in appropriate situations," said Dr. Moore, assistant professor in the department of emergency medicine at Yale School of Medicine. "Point-of-care ultrasonography may also allow more widespread, less expensive screening for certain illnesses."

"Ultrasonography quality has improved dramatically and machine sizes and prices have shrunk even more dramatically," said Dr. Copel, professor in the department of obstetrics, gynecology, and reproductive Sciences at Yale. "The quality of images available now on inexpensive handheld machines is better than those of systems that cost over [US]$100,000 15 years ago."

Some medical schools are training students to use ultrasound before they choose a specialty, according to Dr. Moore. He points out that ultrasound has been used on Mount Everest, the international space station, and in battlefield situations, an indication of its versatility as a diagnostic tool. But he cautioned that haphazard use of ultrasonography could lead to unnecessary testing, unnecessary interventions in the case of false-positive results, or inadequate assessment of false-negative findings.

"More imaging could simply lead to increased expense without added benefit, or might even be harmful without appropriate training and quality assurance," concluded Dr. Moore. "As this technology grows, we need a better understanding of when and how it can be used effectively and competently."

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