Ultrasound's shrinking role in radiology needs attention

Will radiology in the U.S. retain a preeminent role in ultrasound? We've looked at this question extensively in the past few months: a column by Dr. Brian Garra in our June edition ("Radiology must change to retain ultrasound role," page 27), a feature article this month by staff writer H.A. Abella ("Strategies could lead way to a better grip on ultrasound," page 47), and a commentary this month by Dr. Edward Grant ("Diagnostic ultrasound withstands the test of time," page 55). Grant is fairly optimistic about the prospects for ultrasound in radiology, but others are less so. Our view is that radiology can continue to lead the way in ultrasound in the U.S., but whether it will do so remains an open question.

Some worrisome signs are on the horizon. Probably one of the worst is the observation that many radiology residents are just not interested in learning how to collect and interpret ultrasound images. When you stop training people in a field, your options for action immediately begin to narrow.

It has also become apparent that U.S. radiologists are falling behind their international counterparts in ultrasound research and practice. The unavailability in the U.S. of ultrasound contrast for all but the most limited applications is a factor. So are the greater concerns outside the U.S. about the hazards of ionizing radiation and the cost of medicine, two areas where ultrasound shines.

Other problems affecting ultrasound are low reimbursements compared with CT and MR and the difficulty many facilities face in providing round-the-clock scans performed by a dedicated sonography staff.

To date, radiologists in ultrasound have comforted themselves by saying they retain control of the high-end procedures and are frequently consulted when less skilled physicians come across findings they don't understand. So far, this has proved true.

Still, risks for radiology remain. One is that a lack of resident training in ultrasound will gut the knowledge base and remove even high-end procedures from the domain of radiology. Another is that increasing specialization and equipment refinements will level the playing field between radiologists and nonradiologists.

On the positive side, continued technology advances, including volume imaging and speckle reduction, are increasing the effectiveness and desirability of ultrasound. (Our November and December editions will detail how these advances are playing out in practice.)

In addition, some of the leaders in ultrasound are looking at the problem and proposing solutions. The commentary by Dr. Garra in our June issue provided an excellent discussion of ultrasound's shrinking role in radiology and suggested a series of concrete steps that could strengthen radiology's position. Elements include better image quality, wider coverage of anatomy, and more consistency to practice, particularly in the way ultrasound images are collected.

Those steps will certainly help, but it is also important that radiologists recognize the danger of letting ultrasound slip too far away. Beyond Dr. Garra's prescriptions, radiologists should:

- Accept that some portion of ultrasound will move permanently to other medical specialties, that those specialists will need training to use it properly, and play a leadership role in setting standards for education and practice.

- Support efforts to boost reimbursements and to make ultrasound contrast more available to U.S. physicians.

- Find ways to make ultrasound more attractive to radiology residents.

Radiology as a specialty is best served when it encompasses a variety of imaging modalities. Radiology must take steps now to assure that it retains a solid leadership role in ultrasound.

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com.