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Hand-held ultrasound gaining acceptance around the world
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Recent advances in the development and use of hand-held ultrasound units have some touting the technology as the next stethoscope. At the very least, hand-held ultrasound is helping cardiologists with everything from training medical students to enabling people in some of the world’s poorest areas to obtain proper diagnosis and treatment.
Since February 2010, when GE Healthcare Systems launched Vscan, the first hand-held ultrasound unit available in the United States, investigators have used the device in innovative ways. One thing their efforts all have in common is that the device addresses the need for a quick, simple and cost-effective look at the heart.
In that way, it represents the evolution of the stethoscope, said Jagat Narula, MD, PhD, associate dean for global health and director of the cardiovascular imaging program at Mount Sinai Hospital.
Jagat Narula
“Hand-held ultrasound machines are being incorporated in our curriculum at the Mount Sinai School of Medicine,” Narula, who is a member of the Cardiology Today Editorial Board, said in an interview. “With ultrasound, you can truly look into the chest and, in fact, it is the ‘real’ stethoscope. The traditional stethoscope — stethos, which means chest, and, scope, which means to see — is an indirect way of looking into the chest.”
“Because [our hand-held ultrasound] was developed for cardiology, it has a low-frequency probe range of 1.7-3.8 MHz that enables healthcare providers to look between 6-24 cm deep into the body, including where the heart is,” said Tom Gentile, president and CEO of GE Healthcare Systems. “The image quality is about the same as a high-end system from 7 to 8 years ago.”
A useful tool for medical education
Hand-held ultrasound has the potential to transform medical education, Narula said.
“Medical education has continued to be the same for hundreds of years. My grandfather read the same anatomy dissectors, my aunt read the same, I read the same dissectors, and my daughter did the same. If we don’t change now, my grandchildren will be going through the same routine,” he said.
As part of an investigator-initiated project, GE Healthcare Systems made available to Mount Sinai Hospital about 80 hand-held ultrasound machines. Narula and colleagues started giving the medical students the hand-held devices, much like they do with stethoscopes. First- and second-year students have used the hand-held units to learn what a normal heart or other organs look like, and would use the devices in the clinic to learn what abnormal looks like. The interns in internal medicine carry the hand-held devices in units and a rapid response system is being development to make a more efficient bedside diagnosis.
“I firmly believe that the hand-held ultrasound is to be used as a tool of examination and not as a tool of investigation,” said Narula, who is also editor in chief of the Journal of the American College of Cardiology: Cardiovascular Imaging.
Worldwide transformation of care
Developing countries and patients living in remote areas of the world face a dual challenge of high rates of CVD and barriers to the accessibility of diagnostic and referral programs. Performing echocardiograms via hand-held ultrasound plus the addition of a cloud-computing environment has facilitated better care for these patients.
Narula and colleague, Raja Babu Panwar, MD, vice chancellor of Rajasthan University of Health Sciences, are working in India to train health care extenders how to use the hand-held units on patients in remote areas. They are able to upload the images onto the “cloud” and a physician at the tertiary care center will be able to read the echocardiograms.
One group hoping to soon be using hand-held ultrasound in remote areas of Africa is Seed Global Health, which collaborates with the Peace Corps to send doctors and nurses around the world as medical educators. Seed Global Health is posting people to hospitals around Africa to help train others. They aim to do their teaching with hand-held ultrasound because “in a resource-limited setting, you don’t really have access to appropriate diagnostics to be able to do management and care,” Vanessa Kerry, MD, MSc, CEO of Seed Global Health, said in an interview.
This technology can help “uncover the pathophysiology of what’s going on in these patients, in real time, so that everyone can participate in the discussion and the information can be used to manage care,” Kerry added. “It’s a powerful tool. It is very difficult to bring a CT scanner [to remote areas] and keep up the maintenance and accessibility. The power of hand-held ultrasound is that it’s mobile.”
Another group that has experienced the payoff of using hand-held ultrasound is Partners In Health, a global health organization dedicated to improving the health of the poor. The organization has contributed greatly to getting proper care for people in poor, remote areas in Haiti, Rwanda and Burundi, said Gene Bukhman, MD, PhD, a cardiologist at Partners In Health.
“The vast majority of HF and advanced heart disease in areas of extreme poverty is not ischemic. In fact, left ventricular dysfunction tends to be global in nature,” said Bukhman, assistant professor of medicine at Harvard Medical School and director of its Program in Global Non-communicable Disease and Social Change. “Second, the people we are treating are younger and not obese, compared with patients in the United States. Therefore, it is less challenging to get a good image.” Partners In Health has generally used portable ultrasound units from Sonosite, and GE, which are about the size of a laptop.
“This [technology] could be revolutionary for lots of sub-Saharan Africa and other places with similar epidemiology,” he added. “We can finally confirm whether someone is suffering from HF or, say, tuberculosis. This has huge potential to bring them into the health system, and get them cardiac surgery or other treatments.”
Potential future uses
How quickly the hand-held ultrasound technology will catch on worldwide will in part depend on cost. The Vscan currently sells for about $8,000, but the price will come down as the technology improves, Gentile said.
“In the next generation, we hope to be able to leverage off-the-shelf technology for displays to drive down costs. We will also improve the user interface and … improve connectivity. We want it to be seamless, and one way to do that is to leverage cloud services for data privacy and security.”
“We have forgotten the art of examination. With the hand-held ultrasound unit we should be able to bring it back,” Narula said. “Five minutes spent with the patient during ultrasound examination will also bring back the patient-physician relationship. Now that we have the technology, we must use it right.”
Disclosure: Bukhman reports no relevant financial disclosures. Gentile is president and CEO of GE Healthcare Systems. Kerry reports no relevant financial disclosures. Narula reports receiving research support provided by GE Healthcare for devices for medical school teaching and for training of interns and residents.