Dr. Wiese touts the sheer amount of what hospitalists can use ultrasound for. “You can do echoes and abdominal ultrasound—not at the level of the radiology room or the cardiology lab, but you can get a quick look,” he says.
Should other hospitalist programs go in the same direction? “From a quality perspective there’s no question you go down that road,” Dr. Wiese asserts. “You do the math: How much does one pneumothorax cost? That’s especially true if [a] pneuothorax finds its way to CMS. One pneuomothorax that you prevent probably pays for your [$20,000-$30,000] machine. That’s even before you get into issues of billing for the use of it, which I think is a secondary way of funding the purchase.”
Forging Ahead
In the meantime, researchers are focusing on ever-diverse applications and smaller units.
At the Mayo Clinic in Jacksonville, Fla., director of regional anesthesia Steven Clendenen, MD, has pioneered the use of ultrasound for guiding nerve blocks.3 The imaging has “totally revolutionized” how the hospital manages pain, he says. As yet, the device still is cart-based, though he expects its size to shrink considerably. “You remember the first calculators, how big they were, and now look at them,” he says.
Beyond working toward miniaturized ultrasound units, Duke’s Smith has been developing real-time three-dimensional angiograms of blood vessels in the brain, a potential boon for stroke diagnoses.4 Another project may bring hospital-based ultrasound full circle: a device that produces a 3-D stereo-image, “like in the IMAX theater,” he says.5 Smith and his colleagues have modified a commercial scanner, “so the target comes out of the screen at you.” Among the many potential uses, expectant parents could see a 3-D stereo view of the developing fetus—something not even the iPhone can offer. TH
Bryn Nelson is a science journalist based in New York.
References
- Hind, D, Calvert, N, McWilliams, R, Davidson, A, Paisley, S, Beverley, C, Thomas, S. Ultrasonic locating devices for central venous cannulation: meta-analysis. Br Med J. 2003;327(7411):361.
- Fedson, S, Neithardt, G, Thomas, P, et al. Unsuspected clinically important findings detected with a small portable ultrasound device in patients admitted to a general medicine service. J Am Soc Echocardiogr. 2003;16(9):901-905.
- Feinglass NG, Clendenen SR, Torp KD, Wang RD, Castello R, Greengrass RA. Real-time three-dimensional ultrasound for continuous popliteal blockade: a case report and image description. Anesth Analg. 2007;105(1):272-274.
- Smith SW, Chu K, Idriss SF, Ivancevich NM, Light ED, Wolf PD. Feasibility Study: Real time 3D ultrasound imaging of the brain. Ultras Med Biol. 2004;30:1365-1371.
- Noble JR, Fronheiser MP, Smith SW. Real-time Stereo 3D Ultrasound. Ultrason Imaging. 2006;28:245-254.