A modest proposal
Technologist-centered ultrasound is the current reality for a majority of routine ultrasound requests. There are several professional organizations that seek to advance the scope and competence of ultrasound studies. Most of the technologists I have ever met have impressed me with their desire to improve and their eagerness and desire for educational opportunities. If it's not a personnel issue, what else remains?
Everyone who does ultrasound is dependent on their equipment. What I think the companies should do -- and what the users need to demand -- is for every manufacturer to make just one model of equipment and that one should be the best that they can do. And, also like the early days of ultrasound, every unit should be complete with a full range of transducers and software routines.
There is an important ethical issue here. It is not possible to justify using diagnostic equipment with limited performance on patients when better alternatives are present within the same facility or the nearby community. Patients will suffer whenever things cannot be seen clearly for any reason. From the user's standpoint, the least experienced need high-performance gear because they have the greatest need for clear visualization of anatomy. Conversely, the least experienced cannot improve if they are limited by equipment performance.
I strongly suspect that if the manufacturers get rid of everything except the best units they can possibly make, the massive cuts in the infrastructure required to sustain those operations will be reflected in significantly lower costs for the remaining so called "high-end" equipment.
Equipment performance is not an area in which we can afford to compromise. Getting rid of reduced-performance equipment (and the often conflicting, possibly enthusiastic marketing that goes with it) will be a giant step toward establishing general performance standards that the field desperately needs and which are specialty independent.
What I am suggesting does not mean that somebody shouldn't manufacture equipment that has a very limited clinical application, such as a handheld unit for locating fluid spaces for tapping, but the limitation should be exactly specified (and designated by the U.S. Food and Drug Administration [FDA]). Similarly, the FDA should adopt a global safety mandate for all applications of ultrasound, rather than requiring manufacturers to provide separate datasets for individual applications, which raises costs, diverts development resources, and delays introduction of new diagnostic ultrasound techniques where they may be most needed.
We will still need brand choices, even if service and reliability are equivalent, because there are different ways of achieving ultrasound imaging and its ancillary features, such as Doppler, shear-wave elastography (SWE), panoramic views, archiving, analysis, and reporting. Most ultrasound companies started as small ventures initiated by a new concept and a sincere desire to help. In many instances, the motivating factors of the engineering or business sides of development included the grief of an illness or loss of a loved one, just like why many of us are involved with the patient side of medical care.
To be sure, those companies make a major investment in time and work and are entitled to profit from their labors. The ultrasound community and our patients need to support those manufacturers who adhere to their early mission and who make concrete steps to make their very best works available to the entire community in an affordable way.
Ultrasound Olympics
I am sure it is exceptionally naive, but I tend to see medicine and the practice of ultrasound as a serious competition with the health or well-being of the patient as the goal. In this, we are competing with ourselves, always trying to do a new personal best every day and for every patient interaction whatever the context.
Like a team, we should all be supporting and helping each other, reserving all our competitive spirits and abilities against death and disability and supporting wellness the rest of the time. When I see a television ad for some hospital or healthcare system that claims it is the absolute best in the area or in some specialty service, I get very discouraged because the claim implies a misplaced competition.
We need to strive for an equal and high level of competence and performance across medicine. As individual ultrasound competitors, it is important that no one be hobbled by low-performance equipment or any kind of industry judgment that some users or facilities are only capable of a reduced level of service. Our innate drive and the educational resources of our colleagues and our societies will accomplish the rest.
Dr. Jason Birnholz is a graduate of Johns Hopkins School of Medicine and did his diagnostic radiology residency at Massachusetts General Hospital. He was awarded an advanced academic fellowship from the James Picker Foundation and has been a professor of radiology and obstetrics.
The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnie.com, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group.
