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by the American Institute of Ultrasound in Medicine J Ultrasound Med 22:321-322 • 0278-4297
It Is Time for the SonoscopeHughes Center for Fetal Diagnostics, Arnold Palmer Hospital for Children and Women, Orlando, Florida USA It has been many years since my days as a medical student. However, I still remember buying my stethoscope, ophthalmoscope, and otoscope as I readied myself for my first physical diagnosis course. I believe that in the near future, medical students will also be buying a "sonoscope." There has been a spectrum of opinions about this concept from those involved in sonographic imaging. Let me tell you why I think that the sonoscope is a wonderful idea—if it is introduced and used properly. First of all, I specifically use the term sonoscope for a very small, inexpensive, basic sonographic device with good resolution. We need to get rid of the term handheld sonography for this type of device. I think that it is essential that these small sonographic devices be considered as aids to physical diagnosis and not as sonographic imaging devices. We need to differentiate between the use of a sonoscope during a physical examination to detect the edge of the liver, to further characterize a pulsatile abdominal mass, or even to look at the gallbladder in a patient with right upper quadrant discomfort from a sonographic imaging procedure. The sonoscope should be used by a clinician to enhance the physical examination. No images should be taken, and no charge should be generated. This is what currently happens when a clinician uses the stethoscope, ophthalmoscope, or otoscope. If there is an abnormality seen or suspected with the sonoscope, the patient should be referred to an accredited ultrasound facility for a sonographic examination in which published examination standards are followed. This scenario will probably lead to an increase in the number of these imaging procedures, because sonoscopes will be "screening" an enormous number of patients. Is this any different from patients being referred to cardiologists when abnormalities are thought to be heard with a stethoscope? If sonoscopes are considered sonographic imaging devices, and if there are charges generated by their use, it could be disastrous for all currently involved with true sonographic imaging: users, patients, and even equipment manufacturers. The number of sonographic examinations performed throughout the United States would increase astronomically because of the large number of clinicians. The practice expense for sonographic examinations would markedly decrease, because sonoscopes are very inexpensive compared with the high-end machines we currently use. This combination would lead to a precipitous drop in reimbursement by the government and third-party payers. This would set off a domino effect all the way back to equipment manufacturers. Sonologists and their institutions will not be able to afford to buy the high-resolution sonography machines that we have now, let alone future equipment with new advances, if reimbursement is low. We could see major imaging companies no longer developing and producing sonographic imaging machines. If this were to happen, there would be no need for sonographers, and that profession could disappear. Let us not forget the patient—our primary concern. There is the danger of a large number of misdiagnoses due to use of these small sonographic devices by inadequately trained physicians. Not only is this dangerous for patients, it also would give sonography a bad name as an imaging modality. What do we need to do to differentiate a sonoscope used during physical diagnosis from a true sonographic imaging procedure? I do not have all the answers, but I do have some ideas to consider. Regardless of specialty, there is a vested interest for all of us doing sonographic imaging that follows published standards to continue to promote high-quality sonographic examinations by well-trained professionals. Because the American Institute of Ultrasound in Medicine is a multispecialty society, it would be appropriate for it to organize a multispecialty discussion about this topic. Current and potential future users of sonography need to participate. We need to engage sonographic equipment manufacturers and get them to produce even smaller, less expensive sonoscopes so that they are readily affordable. Perhaps they could even start a program similar to the one Apple Computer has with colleges and universities and sell sonoscopes to medical students at a reduced price through medical school bookstores. Education is a key factor. If medical school students are going to be trained in the basics of sonography and the use of the sonoscope, those of us who are already involved in ultrasound education need to play a role in the development of their medical school curriculum. This will ensure that medical students get appropriate and accurate information regarding the use and limitations of the sonoscope. I understand that what I am proposing is not easy. However, because of advances in technology, we are approaching a defining moment in the use of sonography. We must make every effort to direct its development in a way that preserves and advances its use as an outstanding imaging modality while allowing it to become an aid to physical diagnosis that could improve patient care. This article has been cited by other articles:
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