Ultrasonography has been the main method of tracking pregnancy for a number of years.
However, the cost of the relevant equipment, plus the niche expertise to analyse the imaging has limited the widespread use of the technology in areas of general diagnosis.
This could be slowly changing however. Over the past decade, machines have become cheaper, more reliable, and highly portable.
This progression has essentially taken away 3 pain points from ultrasound being used by general practitioners for frontline medical diagnosis.
In fact, where doctors have access to new, easier to use ultrasound technology; they have been able to spot diagnoses many conditions; and all without having to consult an imaging expert, (we will come on to the training of using today’s ultrasound devices, a little later).
Prices for a 20-minute scan using new portable devices have plummeted too. In the UK it now costs just £56 (€69; $95) for such a scan; whereas a three area magnetic resonance imaging scan would be with £217. (Source: Annex B1_NHS Tarrifs 2017/18)
Clearly the cost of a stethoscope diagnosis is the doctor’s time; however, the current £56 price will only continue to reduce as the ultrasound technology becomes more widespread.
The Latest Portable Ultrasound Machines
The main variable that invites the conversation of whether ultrasound could eventually replace the stethoscope is the fact the latest machines are so portable.
They are able to produce high quality images, and easy to use and are available for as little as $5000.
With a number of doctors (across all manner of fields) using these machines as part of their general medical practice, there is now a large body of literature supporting their use in the developing world.
In fact, for low resource environments, the World Health Organization now recommends portable ultrasound devices as a primary diagnostic tool.
The Increase of Ultrasound Examinations in the UK
This is a clear result of the increasing popularity of this kind of scanning, due to the progress in technology, reduction in costs and ease of use.
Many doctors state the financial and clinical benefits of using image scanning for point of contact diagnosis.
The belief being that these devices will will eventually become a standard tool that every doctor carries.
With this rate of adoption, it does seem likely that the scanner could replace the stethoscope as the symbol of the profession.
“Point of care ultrasound has completely changed our practice,” says Stuart Maitland-Knibb, a GP and clinical lead at Corby Urgent Care Centre. “It is an incredibly useful tool, which allows timely diagnosis and enables onward referral and treatment.”
“It has made a big impact on patient care,” states Richard Wakefield, senior lecturer in rheumatology at the University of Leeds. “It enables me to make confident, early diagnoses and monitor the effects of treatment.”
Despite the fact so many medical professionals, see the future being with portable ultrasound, as with the early years of the stethoscope there is concern that this new technology should only be used by those fully trained to operate them.
Portable Ultrasound and issues of Training
The discussion over training is a controversial one. According to The European Federation of Societies for Ultrasound in Medicine, medical ultrasonography is “fraught with scope for diagnostic error.” and minimum training for portable devices needs to be established.
Deborah Levine, chair of the American College of Radiology Ultrasound Commission states that; “Although point of care ultrasonography may offer faster diagnosis, it is not necessarily better diagnosis.”
Peter Cavanagh, vice-president of the RCR also has concerns: “The biggest issue with point of care ultrasound is that the images obtained with a portable ultrasound machine are usually not stored, and a decision is made at the time by the clinician doing the scan.”
This differs greatly from established imaging, where experts use large, sophisticated machines capable of automatically recording the entire scan.
“There should be no clinicians using ultrasound outside a proper governance system,” Cavanagh continues.
The National Ultrasound Steering Group of the British Medical Ultrasound Society, recommends that local clinical governance boards should be set up to oversee the training, supervision, and audit of all providers of ultrasound imaging services.
Levine holds this view too: “Patient safety should be central, and providers should ensure that ultrasound users are adequately trained and that this is maintained through adequate audit and quality assurance systems.”
However, the medical profession has seen exactly the same attitude with the use of stethoscopes. In the past, its use was restricted to only the experts. You would only see doctors with a stethoscope around their neck.
The situation is very different today however, where the sight of a nurse or general caregiver using a stethoscope is a common one.
With enough time, support and simplification of the technology, the subject on who should use ultrasound scanners will definitely relax.
Whether at that point it will replace the stethoscope altogether only time will tell.
- Solutions: Could a Handheld Ultrasound Replace the Stethoscope? – TMC News
- The Impact of Systematic Point-of-Care Ultrasound on Management of Patients in a Resource-Limited Setting – Am J Trop Med Hyg. 2017 Feb 8; 96(2): 488–492.
- Point of Care Ultrasound: An Overview – American College of Cardiology. Authors: Sofia Melgarejo; Andrew Schaub, DO; Vicki E Noble
- Point-of-care ultrasound: It’s no replacement for the stethoscope – Journal of Family Practic. Author(s): Todd Fredricks, DO