Is ultrasound the visual stethoscope that will change the ob/gyn world?
Dr Hanson is an ISUOG Ambassador, Co-Founder of Colleagues in Care, Senior Partner of Virginia Beach OBGYN, and an Assistant Professor at Eastern Virginia Medical School, Norfolk, Virginia.
Invented nearly 200 years ago by French physician René Laennec, the stethoscope quickly replaced direct auscultation. It was inexpensive to manufacture, easy to use, and portable—a perfect example of disruptive technology that ushered in a new era in medicine in which a noninvasive, non-lethal instrument was used to diagnose disease. The stethoscope subsequently underwent several modifying improvements, the most recent of which was the development earlier this year of a low-cost, high-quality 3D-printed version. (See “Gazan medico team 3D-prints world-leading stethoscope for 30c”: http://www.theregister.co.uk/2015/08/14/printed_stethoscope_cccamp/.)
In ob/gyn, I believe that ultrasound has the potential to replace the stethoscope. First applied in medicine 70 years ago and with broad relevancy across multiple specialties, ultrasound has already replaced portions of the traditional diagnostic clinical exam. In ob/gyn, it is used to assess pelvic adequacy and labor progress and to conclusively determine fetal position. Adnexal masses are indisputably best diagnosed with transvaginal ultrasound.
Ultrasound has applications in other specialties, too. In cardiology, transesophageal ultrasound is used to evaluate heart function and in trauma medicine, patients are evaluated with the FAST exam (Focused Assessment with Sonography for Trauma). Astronauts also use the technology to assess fractures, which are prevalent in space. Doppler and 3D/4D ultrasound allows us to hear and see more than senses or stethoscopes alone can comprehend. Therapeutic uses of ultrasound include lithotripsy, uterine fibroid ablation, and treatment of tendonitis and bursitis. Simulation and robotics are active areas of investigation for training and delivery of services.
The advantages of ultrasound include portability, relatively low cost compared to other imaging options, lack of radiation exposure, and ability to see soft tissue as well as bone. It is not, however, risk free. Attention to safety by reducing negative bioeffects is paramount. (See the ISUOG safety statement at http://www.isuog.org/NR/rdonlyres/CC3087DF-08B8-4870-A6CD-B47146568A6B/0/ISUOGSafetystatement2003.pdf.)