AJR 2000; 174:1201-1202
© American Roentgen Ray Society
Centennial Sounding Board |
Sonography
Unlikely Success, Uncertain Future
Christopher R. B. Merritt1
1
Department of Radiology, Division of Ultrasound, Thomas Jefferson University
Hospital, Ste. 796E Main, 132S. 10th St., Philadelphia, PA 19107-5244.
Received January 4, 2000;
accepted after revision January 6, 2000.
Address correspondence to C.R.B. Merritt.
Introduction
Looking back at the early images composed of squiggles and dots,
unrecognizable to all but their creators (and in many cases probably
unrecognizable to them as well), it is hard to see how sonography ever
happened at all [1]. Yet from
humble and improbable beginnings, sonography has become one of the great and
most unlikely success stories in medical imaging. Far more important than the
simple technology used to produce the first sonographic images was the
extraordinary vision and effort of clinical pioneers who recognized the
potential of sonography and made it work despite formidable odds. Sonography
is now the most widely used and rapidly growing of all sectional imaging
methods. Commonplace radiographic examinations such as oral cholecystography
and pelvimetry have been rendered obsolete by sonography, and entire new
specialties—perinatology, noninvasive vascular testing, and women's
imaging—have been created under the influence of the unique capabilities
of sonography. Today's success of sonography has occurred through the mastery
of complex skills augmented by technology, and even today sonography remains
the most technically demanding and physician-dependent of all imaging methods.
As medical imaging advances into its second century, sonographic technology
is evolving at a pace more rapid that at any other time in its history.
Scanners are now available that are small, inexpensive, and loaded with
features that a few years ago were found on only the most sophisticated and
expensive machines. Accompanying these technical developments are an expanding
range of clinical applications for sonography. Although the success of
sonography is good news for those of us in radiology who have devoted years of
effort to promote it and expound its benefits, it is, paradoxically, a time
when sonography faces its greatest danger and a most uncertain future.
Inexpensive hand-held scanners are now widely available to practitioners. Just
as today's practice environment is requiring most radiologists to be adept in
many imaging techniques, clinicians are under great pressure to see more
patients and to diversify the services they provide. In this environment, it
is easy to see why sonography has grabbed the attention of clinicians as well
as radiologists. The popularity of sonography, the availability of its
relatively low-cost scanners, and the lack of known risks or contraindications
to its use (not to mention the opportunity to generate income) have stimulated
many clinicians to acquire sonographic scanners and to examine patients
themselves. As Roy Filly foresaw in 1988, the sonographic stethoscope has
arrived [2]. Unfortunately, and
despite good intentions, most clinicians have been led to believe that
sonography is easy to learn and that the basic skills to perform simple
examinations can be mastered in a few hours or days. The inevitable result is
poorly performed studies, misdiagnosis, and disastrous results for
patients.
Somewhere along the way, technology rather than training has been perceived
by the public and by many physicians as the path to better patient care. In
most imaging methods—perhaps more so in the case of
sonography—technology counts far less than training in producing the
desired outcome. It is a simple and not well-appreciated fact that the value
of sonography ultimately is determined by the training and experience of the
individual performing and interpreting the examination, and not by expensive
and sophisticated technology. Just as a rare violin in the hands of an amateur
is unlikely to please an audience at Carnegie Hall, sonographic equipment is
unlikely to produce acceptable results in the hands of an untrained and
inexperienced user. Unfortunately, as more and more examples of serious
misdiagnoses with sonography performed by untrained and inexperienced
physicians are seen, guess what gets the blame? Not the errant physicians, but
rather the technology—and herein lies the greatest threat to the future
of sonography. The rapid proliferation of sonography into unskilled hands, if
not accompanied by appropriate training and standards, will ultimately
discredit all of sonography—a disaster to those who have, by hard work
and effort, mastered this demanding field; a tragedy for patients subject to
misdiagnosis and more hazardous, expensive, and, in some cases, less effective
studies; and a catastrophe for the sonographic industry, which will see its
business evaporate as faith in sonography is lost.
The American Roentgen Ray Society and the imaging disciplines it represents
now enter their second century on a wave of technology.
Technology—modern electronics, computers, and the like—clearly
deserves much credit for the success of imaging. Now our challenge is to use
this technology to build and enhance the skills of radiologists in all imaging
techniques and to promote the value of the skills, training, and technology we
bring to patient care. In her 1999 ARRS presidential address
[3], Dr. McLoud emphasized
issues in education facing our profession. Unlike many of our clinical
colleagues, radiologists recognize that the value of sonography in patient
care is not provided by high-tech equipment alone, but is realized only
through the skill and knowledge of a well-trained user. To ensure the future
of sonography and the value it has achieved in patient care, we must approach
the next decade with a resolve to strengthen the role of radiologists in
sonography through education, accreditation, and research. Through this
defense of the high standards that radiologists have set in diagnostic
sonography, the unlikely success of sonography in medicine may in fact be
extended into a healthy and productive future.
References
-
Leopold GE. A sound perspective. AJR
2000; 174:9
-15[Free Full Text]
-
Filly RA. Ultrasound: the stethoscope of the future, alas
(editorial). Radiology 1988;167
: 400[Free Full Text]
-
McLoud TC. Education in radiology: challenges for the new
millennium. AJR 2000;174
: 3-8[Free Full Text]
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Introduction
References
