Radiologists Must Play Central Role in Point-of-Care Ultrasound Training

The rise of point-of-care ultrasound has many in the radiology community concerned about lost business and shortfalls in patient care. But point-of-care should not be viewed as a threat and may even present opportunities for radiologists to become more relevant in the ultrasound sphere, according to two leading authorities who presented at a Controversy Session Wednesday.

By Richard S. Dargan

In only a few decades, ultrasound has evolved from refrigerator-sized machines on carts to relatively inexpensive devices that fit in the palm of the hand. These developments, along with concerns over radiation exposure, have launched a boom in ultrasound and put the modality "within the reach of anybody," said co-presenter Brian D. Coley, M.D., a pediatric radiologist at Cincinnati Children's Hospital and treasurer of the American Institute for Ultrasound in Medicine.

David Bahner, M.D. and Brian D. Coley, M.D.

"From the perspective of radiologists, there is plenty of fear and trepidation and in some cases anger about anybody but radiologists doing ultrasound," Dr. Coley said. However, much of this fear and anger is unfounded and fails to recognize the potential benefits of point-of-care ultrasound to medicine—an opinion he acknowledged might be unpopular in a room full of radiologists, he said.

"What if I told you that point of care ultrasound could be a good thing?" he asked. "There is real, evidence-based data showing that in the right hands with the right training, it's a very powerful tool for patient care."

The prospect of radiology losing business to point-of-care ultrasound is also likely overblown, according to Dr. Coley. Point-of-care applications are for different issues, he said, such as resuscitations and other procedures where time is of the essence. "Ultrasound is one of the few areas in imaging where not everyone is trying to divide up the same pie," he said. "Ultrasound volumes are not dropping in the radiology department because point-of-care applications have made the pie bigger."

Still, concerns persist over non-radiologist physicians doing ultrasound without adequate education, training and experience. Even the so-called "yes or no" questions answered in a focused ultrasound exam carry with them the possibility of false-negatives, Dr. Coley noted.

"It's not an easily answerable problem other than making sure the people at the point of care are well trained and educated." he said.

Training Must Begin Early

That education and training should begin in the first year of medical school, said session co-presenter David Bahner, M.D., director of ultrasound at the Ohio State University Department of Emergency Medicine in Columbus. "Ultrasound in medical education is growing," he said. "Barriers exist, including a lack of space, equipment and financial support, but they can be overcome."

Dr. Bahner expressed frustration with the slow pace of change, noting that almost a third of U.S. medical schools are lagging behind in bringing ultrasound training into the curriculum. He attributed the slow adoption to a problem common in medicine, what he described as a "cacophony of voices."

"We're all speaking with different voices when we need to speak with one, and that's why a lot of healthcare is broken," he said. As an example, Dr. Bahner noted that representatives of the Accreditation Council for Continuing Medical Education (ACCME) visit medical schools, but don't check for ultrasound programs or cite institutions lacking in such programs.

With medical education struggling to catch up to the boom in ultrasound, it's more essential than ever that radiologists drive the discussion and ensure quality care, Dr. Coley said. "There has been a contentious history, but there also are many areas of collaboration," he said. "For instance, the medical executive committee often will go to the radiologist and ask what the requirements should be for non-radiologists to use ultrasound. And if you volunteer to help, 99 times out of 100 you will be welcomed with open arms and you can direct the course for a particular institution. "

"Radiologists are finally coming around and saying, 'we have to be involved,'" Dr. Coley said. "It's not the same field it was 30 years ago and that's OK."

Opinions on the issue seemed split during the question-and-answer session following the presentation. One radiologist in attendance wondered about the strength of the data supporting point-of-care ultrasound's value. "If you doubt that the data is robust and really solid, then you haven't really looked at it," Dr. Coley said.

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