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American Way

Diagnosis in Hand

For some doctors, the portable ultrasound is set to become “the stethoscope of the 21st century.” (2015)

By Charlotte Huff

Each time Dr. Steve Freeman enters a patient room, the internist in rural South Carolina carries with him an ultrasound device the size of a hefty smartphone, relying on its imaging capabilities for even routine patient visits.

Freeman credits that device, which generates the sort of ultrasound images familiar to any expectant parent, with ­supercharging his diagnostic capabilities as he quickly scans a patient’s heart, lungs and other organs. Over the last several years, he’s identified two cases of gallstones, numerous instances of enlarged prostates and likely his most dramatic save to date: a worrisome bulge on a patient’s aorta.

That crucial artery, which supplies blood from the heart through the chest and abdomen, was so large that it was vulnerable to rupturing, and the man was sent by ambulance to the hospital, Freeman says. “He was not having any symptoms.”

If proponents like Freeman have their way, this sort of diagnostic scenario will play out more frequently over the next decade. Will that increased reliance upon such portable imaging improve patient care, catching medical problems sooner, or will it simply run up treatment bills and patient anxiety? The perspective, not surprisingly, depends on whom you ask.

The ultrasound devices, a long-standing fixture in hospitals, are catching the attention of doctors in private practice as they become more portable and affordable, says Dr. Richard Hoppmann, who directs the Ultrasound Institute at the University of South Carolina School of Medicine, one of the first to train medical students. “It’s just a matter of time before it truly becomes the stethoscope of the 21st century. The bottleneck right now is adequate training.”

In recent years, though, other schools have begun to incorporate such training, some on a pilot basis, including Harvard Medical School, New York City’s Icahn School of Medicine and the University of California, Irvine. Once that next wave of physicians launches their practices, they can use the devices — some hand-held and others more the size of a laptop — to check for potential medical issues ranging from heart failure to fluid on the lungs to a blood clot in the legs without vacillating about whether to refer the patient elsewhere for testing, says Dr. Nilam Soni at the University of Texas Health Science Center at San Antonio, which began to train all incoming students this year.

“None of us want to be wrong,” says Soni, who co-directs his school’s new ­ultrasound curriculum. “It gives us a level of confidence in the decision-making that we didn’t ever have before.”

Who wouldn’t want to be Freeman’s patient, avoiding a potentially life-­threatening rupture of the aorta?

Some research, however, provides a cautionary note, indicating that more imaging might not only trigger more costly and anxiety-provoking tests but also might “catch” a medical issue that might not have caused long-term problems anyway. One 2014 study found that diagnoses for thyroid cancers — some of which can be quite slow growing — have nearly tripled since the mid-1970s. Yet the death rate hasn’t changed, suggesting that the problem might be an “epidemic of diagnosis” via imaging tests rather than an “epidemic of disease,” the researchers wrote.

But portable ultrasonography can streamline diagnoses in some circum­stances, says Dr. Dan Sepdham, associate professor of family and community medicine at University of Texas Southwestern Medical Center in Dallas. Sepdham, who started using a laptop-size device last fall while training physician residents, describes one woman he treated recently in an outpatient clinic at nearby Parkland Hospital. The woman had previously been prescribed antibiotics for a sore throat but had returned still in significant pain. A portable ultrasound scan found a fluid-filled area not otherwise visible — a pocket of infection that could have spread to her airway — and sent her to the emergency room.

The image on the ultrasound screen can also help doctors educate their patients about vague-sounding medical terms like heart failure, Soni says. “There is the saying that a picture is worth a thousand words.” For example, a patient short of breath can see fluid on the lungs and better understand why it needs to be drained, he says.

Doctors need to learn to correctly decipher what they’re looking at, says Dr. Louise Davies, a head-and-neck surgeon with the Veterans Affairs Medical Center in Vermont and a researcher on the ­thyroid-cancer study. “People see small variations and say, ‘That’s abnormal.’ ” What if a very small area of fluid is flagged near the lungs? Should that be drained?

“You can imagine that it’s definitely going to lead to a lot of additional testing, at least initially,” Davies says. “Will it be 10 years from now? I don’t know. Certainly there’s a learning curve with the introduction of any new technology.”