Leave the Ultrasound Imaging to the Experts

December 10, 2013

Ultrasound is being used more at the bedside by all specialties. But for non-emergencies, leave it to the experts or risk over- or under-diagnosis.

As a practicing musculoskeletal interventional radiologist, I use ultrasound often in diagnosing and treating disorders. My colleagues in other specialties of medicine often remark how easy ultrasound is and how they should incorporate the imaging modality in their clinical practice. I usually given them a half nod and go about my business.

I believe medicine is in an ultrasound boom. There are many reasons for this, including increased radiation concerns with other imaging modalities, stable reimbursements for ultrasound, and increased portability of ultrasound machines.

Although non-radiologist physicians can take courses to utilize ultrasound in their practices, many do not understand the basic fundamentals of ultrasound imaging, including the physics behind creating images. As radiologists understand, ultrasound images often have artifacts which can lead to misdiagnosis. Also, unlike other imaging modalities, ultrasound is highly user dependent, and in the wrong hands, can lead to over- or under-diagnosis.

Radiologists are thought of as the imaging expert but in recent years with reimbursement cuts and physicians looking for other avenues to supplement their income, imaging has been shifted to nonradiologist practices. 

I recently came across a posting on KevinMD.com which discusses the usefulness of ultrasound at the bedside for general internists. This is one of a handful of posts I have come across recently from various medical specialties. The post basically discusses how ultrasound can increase the accuracy of detecting disorders and also diagnosing occult disorders by the general practitioner. 

Although I agree that ultrasound is a great test to help diagnose and treat disorders, it should not be used ubiquitously by semi-trained users, as it may increase detection of diseases but can also lead to a false level of assurance and over-diagnoses.   

During my training, emergency room physicians began to perform ultrasound at the bedside.  After that point the radiology department ultrasound volume increased significantly from the ER. The main reason for this was the ER physicians often thought they found an abnormality on ultrasound and upon further review in our department the finding was either a normal structure or an artifact.

I do agree that portable ultrasound may be beneficial in certain emergency situations, including but not limited to evaluating for a deep venous thrombosis, pleural effusion, and abdominal ascites/hemorrhage. However, for non-emergent situations, the study should be performed by an expert in ultrasound imaging. In today’s healthcare environment where cost along with outcomes are at the utmost importance, imaging should be kept in the hands of the experts and will ultimately lead to better, more efficient care.