IMPACT AND CHANGE OF ULTRASOUNDS

Innovation in History: Impact and Change of Ultrasounds

Innovation in History: Impact and Change of Ultrasounds

Introduction

Over the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied.

Innovations in ultrasound have their origins in a large variety of fields of science and engineering. This includes material science, solid state physics, electronic engineering, computer science, pharmaceutical research. These are the driving force behind the success story of this imaging modality in medicine (Spencer, 2008).

They are constantly opening up new doors for clinical applications, with improved image quality and acquisition speeds creating more and refined diagnostic data in a shorter time period. This results in better workflow and clinical outcome.

Impact of Ultrasound on Patient Care

Clinicians indicated on their datasheets that the ultrasound findings changed their initial patient management in 43% of patient cases, with the most common change indicated as a new plan to perform a surgical procedure after the ultrasound. Most often this surgical procedure was a cesarean section, biopsy, or minor surgery. For example, cesarean sections were performed based on ultrasound findings such as unexpected breech position of a fetus, placenta previa, or discovery of a multiple gestation pregnancy. Dilation & curettage procedures were performed after an ultrasound showed retained products of conception in females with vaginal bleeding. Other types of changes in patient care plan based on ultrasound results included medication changes such as adding furosemide for a patient with newly diagnosed heart failure by ultrasound, referrals to specialty clinic, cancelling planned surgical procedures such as paracentesis or thoracentesis if no fluid was identified by ultrasound, and referrals for further radio logic evaluation with computed tomography (CT) scanning (Tshibwabwa et al., 2000).

Sustainability

Sustainability of the ultrasound program was also evaluated. Clinicians continued to perform ultrasounds after the end of the ultrasound training curriculum and departure of foreign teaching faculty with almost twice the number of scans performed in the post training period as during the training period. In the 11 weeks post training, a total of 245 new scans were performed by the local staff at both hospitals with a similar distribution of application type and patient demographics. Previous studies of ultrasound in the developing world have raised concerns about the sustainability of maintaining the machines and upkeep of the technology (Kobal, 2004). In our experience, the two Sonosite Micromaxx ultrasound machines have continued to function without any technical problems for the last 10 months. Ultrasound images from interesting or concerning cases are emailed regularly by the Rwandese staff physicians to the primary author of this paper for real-time quality assurance and assistance with interpretation.

Quality and Accuracy of the Ultrasound

Quality and accuracy of the ultrasound scans performed by the local staff after the training period were ...