Minimally Trained but Maximally Utilized
At this year's Annual American Institute of Ultrasound in Medicine conference, Dr. Brian Garra of the University of Vermont School of Medicine and long-time sonographer advocate made scientific a presentation entitled "Scan Protocols for Use by Nonmedical Personnel in Developing Countries: Organ Visibility and Reproducibility Evaluation."
It described preliminary work that involved the use of volume sonography performed by minimally trained individuals. The concept of the study was that a "non-imaging person" could be trained to perform screening volume scans on low-cost equipment.
To test this idea the researchers developed four scanning protocols (thyroid, gallbladder, renal, and female transabdominal pelvis) that consisted of 4 to 6 volume sweeps. Individuals who had no imaging experience received a 20-minute training session on each protocol and then they scanned each other using surface anatomy to guide where they placed the transducers. The scans were then evaluated by a panel of sonologists to determine the completeness of the scans in terms of organ visualization and for image quality.
What Dr. Garra's group found was that organ visibility was excellent for the thyroid and gallbladder scans but visualization was less optimal but usually adequate for renal diagnoses. Visibility of pelvic organs was good, but (as might be expected) it was dependent on the degree of bladder distension.
The conclusion of the study was that individuals who only received minimal training could perform screening sonography scans.
For very practical purposes this model could be used in rural areas of the world where the availability of sonography services (or any diagnostic imaging services for that matter) is severely limited. The volume scan data could be sent via teleradiology for interpretation and a report could be issued back to the provider who, in turn, might be asked to obtain additional images or provide the patient with medical advice.
This is clearly an untraditional method of providing medical diagnoses and the concept was not embraced (to put it mildly) by some in the medical community. I suspect some sonography professionals feel threatened by the idea of having any Manny, Moe and Jack perform scans, and I do not blame them for feeling that way. A majority of sonographers take their responsibilities very seriously and have devoted a lot of time and expense to become skilled.
However, what the study described above is really proposing is not to replace or obviate the need for skilled sonographers to perform focused diagnostic examinations, but to expand the availability of services into areas that are in dire need (at least for now) of screening purposes.
For these applications I believe the time is right and the concept noble. After all, expanding the utilization of sonography to improve healthcare for everyone on the planet is what it's all about. Considering the recent disasters in Asia, the need for sonography services performed in this fashion may be more important and vital than ever.