Handheld Ultrasound Grips JHU School of Medicine
|Handheld ultrasound is strengthening the patient-physician bond and providing formal training in bedside echocardiography.
Medical residents at the Johns Hopkins University School of Medicine, Baltimore, are now receiving formal training in bedside echocardiography using handheld ultrasound devices supplied by Sonosite Inc, Bothell, Wash. Studies to validate the clinical acceptability of the training are ongoing; a 2005 study1 published in the American Journal of Medicine analyzed students? performance by comparing it to the conventional transthoracic echocardiogram (CTTE) results attained by a cardiologist specializing in echo. After multiple exams, it was evident that students were learning the technique “at a reasonably rapid rate,” explains the study?s lead author, David Hellmann, MD, chairman of the department of medicine at Johns Hopkins Bayview Medical Center.
Showing that residents can learn complicated imaging procedures during their standard rotations is important, Hellmann says, if diagnostic methods are to be altered dramatically by the emergence of new technology. “Ultimately, if you?re going to revolutionize the doctor?s black bag, you need to change the training of the current residents, which is a challenge,” he says. “There are new national requirements for restricting the work hours of residents, and now that everyone?s focused on trying to make sure they don?t exceed those hours, it makes it more difficult to do new training. So, we have shifted our focus of training to hospitalists.”
Held to the “gold standard” of cardiologist-performed CTTE, students learned quickly. “The study suggests that after around 20 to 30 [examinations], they started to get pretty good,” Hellmann explains. “The problem with the study is that it looked at a group average and didn?t establish what?s needed for a particular individual. Those are the studies we?re doing now. ? I believe that this technology will have many advantages, but we need to find out whether that hypothesis is correct. So, what we?re doing is very careful studies to figure out who can use this technology, and what?s the level of training they need in order to use it well.”
Hellmann hopes that handheld ultrasound will prove to be safe, cost-efficient, and more accurate than traditional diagnostic methods. “There?s a lot of evidence that the ability to detect heart function with your hands, ears, and stethoscope is significantly less than your ability to do it with handheld ultrasound,” he says. “I think this technology could improve the safety of placing catheters into veins. I think it could improve the ability to detect abdominal aortic aneurysms.”
A less-tangible advantage?but one with the potential to hasten widespread adoption more than any other factor?is the hands-on aspect of bedside echo. “The younger generation of physicians who are technology-savvy are enjoying this,” Hellmann notes. “The other surprise is that patients are enjoying it. At a time when people are worried about whether technology distances you from a patient, handheld ultrasound is really a laying-on of hands. It could potentially strengthen the bond between patient and physician.”
Hellmann and his team will publish a fresh spate of research on handheld ultrasound training later this year.
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- Hellmann D, Whiting-O?Keefe Q, Shapiro EP, Martin LD, Martire C, Ziegelstein RC. The rate at which residents learn to use hand-held echocardiography at the bedside. Am J Med. 2005;118:1010?1018.
University of South Carolina Begins Ultrasound Study
A new partnership between GE Healthcare, Waukesha, Wis, and the University of South Carolina (USC) School of Medicine, Columbia, SC, will test the educational and diagnostic potential of portable ultrasound devices. Beginning with the class of 2010, students at the School of Medicine will test GE Healthcare?s Logiq e ultrasound units, which are about the size of a laptop computer, weigh 10 pounds, and are designed for general diagnostic use.
“The Logiq e can be used at the bedside, and it has the capability to transfer high-quality digital images anywhere in the world over the Internet in minutes,” says Robert Honigberg, MD, global general manager of medical and clinical strategy at GE Healthcare. “It?s geared toward physical diagnosis and general exams.”
Honigberg explains that the partnership with USC is intended to proliferate the use of ultrasound through the next generation of medical professionals. “The goal is to validate that ultrasound can make a difference in the medical school curriculum, that it will increase scoring on testing?both for courses as well as the ability to make clinical decisions in their clerkships?by helping them understand spatial anatomical relationships. That data is all going to be captured and published. A key audience here is the Association of American Medical Colleges, and if that data looks positive, I think this is something that will definitely be exported to medical schools.”
Medical students at USC will learn about the benefits of ultrasound as a diagnostic tool in fields as different as family, preventive, and internal medicine; surgery; obstetrics and gynecology; and emergency medicine. An ultrasound curriculum has been added for students in their second, third, and fourth years. The program will be Web-based, allowing each student?s scores to be tracked over time.
“The ultrasound program at USC is de-signed as a vertical curriculum, so it starts in their first year and is employed immediately for their anatomy lectures,” Honigberg notes. “They?ll have their cadaver dissection, they?ll get their lecture, and then they?ll be able to go into the ultrasound laboratory and understand the anatomical relationships of what they?re learning. I think having this skill set can only make students more attractive.”
Students also will give feedback on the equipment?s design, and as GE Healthcare refines its portable ultrasound units, the models in use at USC will be refreshed. “It will be an iterative process,” Honigberg says. “And as the machine gets smaller and smaller, it will, of course, become more affordable. The target here is to have technology like this spread to primary care physicians and rural physicians on the front line.”
GE Healthcare also has established a similar relationship with another medical school; however, the company had not revealed its name at press time.
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NASA Uses 3D Ultrasound to Study Effects of Space Flight on Heart
|European Space Agency Soyuz crew member Pedro Duque participates in the Human Research Facility ultrasound proficiency training in the International Space Station Destiny laboratory mockup/trainer at the Johnson Space Center
The National Aeronautics and Space Administration (NASA) is using an iE33 echocardiography system and accompanying QLAB Quantification software from Philips Medical Systems, Andover, Mass, to evaluate the effects of space travel on astronauts? hearts. Currently studying the hearts of space shuttle astronauts, NASA plans to extend the program to astronauts on the International Space Station, as well as ground-based analogs, in the future.
Of particular interest to researchers is the loss of heart mass experienced by astronauts during prolonged space flight; 2D echo has revealed a 5% decrease in heart mass, usually reversed within 3 days back on Earth, but the cause of the change remains a mystery. Some potential explanations are dehydration from space travel, heart atrophy caused by weightlessness, or error caused by the geometrical assumptions used in 2D echo.
The 3D echo system captures a full-volume image of the beating heart in less than 1 minute, allowing researchers to make accurate before-and-after measurements of heart mass, ejection fraction, blood flow, strain rate, and cardiac-wall motion. “We have a very short window of time in which to do an echo exam on the astronauts,” David S. Martin, ultrasound lead for the NASA Cardiovascular Laboratory at Johnson Space Center, Houston, said in a statement. “Live 3D echo allows us to quickly grab all the image data we need to do a full examination of the heart anatomy and function, and send the astronauts on their way. Following the image acquisition, we use off-line analysis software to do several measurements that help us evaluate changes after space travel.”
The iE33 system joins another Philips Medical device: a modified HDI 5000 ultrasound system, which has been in use at the International Space Station?s Human Research Facility since 2001. According to Martin, “These new ultrasound technologies help us efficiently conduct sophisticated cardiac research on astronauts and the effects of microgravity.”
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