Reflections in Real Time : Radiology, Ultrasound

It Just Makes Sense...And Saves Lives

Daniel Merton — Fri, 25 Sep 2009 16:14:00 GMT

The title of the article read "Woman bleeds to death after doctor accidentally punctures jugular while inserting a drip - and no blood is available for transfusion"- clearly a tragic result of a relatively minor procedure gone terribly wrong. Two unfortunate...(read more)

Texas Law Requires Widespread Cardiovascular Screening

Daniel Merton — Thu, 30 Jul 2009 19:14:00 GMT

A new Texas law requires coronary artery calcium (CAC) scans and duplex carotid sonography examinations for ALL men ages 45-75 and women ages 55-75, as well as anyone regardless of age who has diabetes or is considered at risk for heart disease. That...(read more)

The SRU Reaches Out to Sonographers and Technologists

Daniel Merton — Tue, 05 Aug 2008 19:09:00 GMT

I recently received the brochure and registration materials for the 2008 Society of Radiologists in Ultrasound's Annual Meeting. I was somewhat surprised to have received the brochure, because historically the SRU has generally not been very receptive to non-radiologists. In fact, according to the SRU website, http://www.sru.org/, the Society is "...the only ultrasound society in North America which solely represents issues from the perspective of the radiologist" and one must be a radiologist or physician in radiology training to become a SRU member. Thus, the SRU has, in many peoples' opinions, been a rather exclusionary club of sorts that often gave the impression that they believe radiologists are the only medical professionals capable of interpreting sonograms. I've often considered the SRU's membership rather stodgy and insecure for this reason. However, that being said, I also respect those radiologists (SRU members or not) who continue to recognize the clinical importance of sonography and have not abandoned it to concentrate their efforts in more high-tech, lucrative modalities like CT and MRI. On an aside, I also applaud the SRU and other organizations that have joined the Alliance for Radiation Safety in Pediatric Imaging. The Alliance's "Image Gently" campaign's goal is to change medical imaging practices by increasing awareness of the opportunities to lower radiation dose when imaging children.

In any case, at this year's Annual Meeting in Philadelphia the SRU will be offering a "Sonographer and Technologist Luncheon," so clearly they are attempting to reach out to us non-physician sonography professionals. I find it a little disconcerting that the SRU is inviting non-members to their annual meeting but won't allow non-radiologists to become members. It's a little bit like being invited to the black-tie party at the mansion on the hill. Are we supposed to feel honored by the invite? Is the SRU's objective to provide additional educational opportunities for all users of sonography (a noble endeavor) or are they just trying to capture more revenues from professionals outside their club? Maybe it's a little of both. What do you think?

The Piezoelectric Effect: Can it Relieve the Pressures of the Energy Crisis?

Daniel Merton — Wed, 30 Jul 2008 16:32:00 GMT

A colleague recently shared with me a short video that appears on www.youtube.com that describes the potential to use the piezoelectric effect as a form of alternative energy. Sonographers know that the "piezoelectric effect" describes the ability of certain materials to generate an electric charge in response to applied mechanical pressure ("piezein" is Greek for to squeeze or press). This is a fundamental element (pun intended) of ultrasound imaging transducers where an electric charge creates mechanical (acoustic) waves that enter the patient's body and the mechanical pressures (returning echoes) are converted into an electric signal that ultimately are used to create an image on the scanner's monitor.

The alternative energy concept, by car maker Toyota, incorporates lots of piezoelectric elements under a night club's dance floor. The pressure from the dancers on the floor would generate electricity which, in turn, would provide electric power to the club's lights, music system, etc. It's a great idea, and one that might prove useful not only in night clubs but wherever pressure is applied over an area, like sidewalks, stairs and hallways. Perhaps the same concept could be used under roadways or subway systems where significantly more pressure is applied, which would generate even more power.

This got me wondering whether the pressure that sonographers apply with the transducer to a patient's body surface could somehow be converted into useable electricity. The more pressure that is applied on the probe (e.g., during a scan of an obese patient) the more electricity would be generated. Maybe you can see where I am going with this: Pressure exerted on the probe during a sonogram could provide power to the ultrasound scanner, thus providing a system that powers itself during use! (Then again, maybe the current heat wave in Philadelphia is causing me to think a little too far outside the box.) I hope you are enjoying your summer.

You can see the video http://www.youtube.com/watch?v=rzb3VFi3Sew.

ARDMS’s Single Physics Examination

Daniel Merton — Tue, 24 Jun 2008 13:32:00 GMT

In case you haven't heard, the American Registry for Diagnostic Medical Sonography (ARDMS) has announced that starting in Spring 2009, a new Sonography Principles and Instrumentation (SPI) examination will be made available. Before all of you who are already certified have a panic attack, I'll state up-front that active registrants who hold the RDMS, RDCS or RVT credentials do not need to take the SPI examination in order to maintain your current credentials.

In the past, there were three different physics examinations: The Ultrasound Physics and Instrumentation (UPI) exam was for applicants who wanted to earn the Registered Diagnostic Medical Sonographer (RDMS) certification; the Cardiovascular Principles & Instrumentation (CPI) exam was for people who wanted to become a Registered Diagnostic Cardiac Sonographer (RDCS) and the Vascular Physical Principles & Instrumentation (VPI) exam was required to obtain the Registered Vascular Technologist (RVT) credential. The rationale behind having three different physics and instrumentation exams was that echocardiographers and vascular technologists needed to be tested more on issues related to Doppler ultrasound and technologies used for those sub-specialties, where as general sonographers (i.e., those holding RDMS credentials) did not need to be tested too heavily on Doppler physics and instrumentation.

The new SPI exam will replace the three existing physics-related exams so that, in the future, applicants will only need to take and pass one physics exam and a specialty exam to become certified.

What the ARDMS did was to remove from the existing CPI and VPI exams any content that was specific to the RDCS and RVT credentials and place those questions on their respective specialty exams. Thus, the 2009 versions of the individual specialty examinations will include some physics and instrumentation questions that are unique to that specialty. Test items that were considered necessary for practitioners in all three credentials were incorporated into the SPI exam.

Given the fact that Doppler ultrasound is used so frequently during virtually all sonography examinations, I think having a single physics exam makes a lot of sense. Furthermore, once the SPI test is available, individuals who are new to the field will only be required to take the SPI exam as opposed to three different physics-related exams which will likely reduce their anxiety as well as save them the time required to study for and take the exam (not to mention a few bucks).

It sounds to me like a win-win situation for all, but I'd love to hear what you think about it.

To read more about the SPI exam visit the ARDMS website.

Sonographer Salaries On the Rise

Daniel Merton — Tue, 10 Jun 2008 18:53:00 GMT

I recently received the results of the Society of Diagnostic Medical Sonography's 2008 Sonographer Salary and Benefits Survey. Every few years the SDMS does a survey and provides its membership with the results---it's a nice benefit of being an SDMS member.

The results contained in the 87-page survey are rather detailed with data provided based on geographical regions, worker ages, types of compensation (hourly, salaried, per diem, etc) and other variables. In addition to compensation, the survey covers such areas as sonographer demographics, work settings, certification, education and job satisfaction. I can't go into too many details regarding the survey results, but I would like to share a little of the information. If you are an SDMS member and you have not received an email offering it to you, the complete survey can be downloaded from http://www.sdms.org/.

The survey indicates that the median salary for sonographers in 2008 is just under $67,000, having increased from about $62,000 in 2005 when the last survey was done. It probably comes as no surprise to learn that the vast majority (87%) of sonographers are female and the percentage of sonographers who are over 50 years of age is increasing.

Sonographers who are in the top salary levels tend to hold several certifications (e.g., RDMS, RVT, RDCS) than those who only hold a single certification. The survey also confirms that most sonographers are employed in hospitals, followed by physician offices (19%) with the third largest practice setting being outpatient clinics (16%). The average number of scans performed per day is 10, with the majority of respondents indicating they perform between six and 15 scans a day.

The SDMS Salary Survey is an impressive body of data that is likely to be beneficial to individual sonographers (e.g., when they want to ask for a raise), as well as to administrators that need to know how their compensation packages stack-up to other employers in their areas. The reported salary increases, job security and employment opportunities available to sonographers and vascular technologists as described in this important document will hopefully also encourage more individuals to pursue a career in DMS.

Spreading the Word: It’s a Two-Way Street

Daniel Merton — Tue, 03 Jun 2008 20:18:00 GMT

For the past several years I've been visiting high schools (and occasionally elementary schools) to teach students about diagnostic medical sonography and the role of the sonographer. Although the primary objective of these trips is to encourage students to consider pursuing DMS careers, I spend the majority of the time just educating them about ultrasound technology and clinical applications---with a heavy emphasis on the fact that its not just used to see unborn babies! I do a prepared PowerPoint presentation first, and then I do a scanning demonstration using a portable scanner (SonoSite) and one of the students as a model.

Last Friday I visited a local high school and provided two separate 43-minute sessions to juniors and seniors enrolled in human anatomy and physiology courses. The highlight of these events is always the scanning demonstrations. Regardless of the age of the students, they are universally amazed at "how cool" it is to peer inside the human body and see things like the heart valves opening and closing and the color flow depiction of blood flow in the carotid arteries and kidneys.

The students and their teachers are very appreciative of what I have to share with them and I must say it's a two-way street---I find the experience immensely rewarding too. Every time I do these "outreach" programs I come away with a renewed appreciation of just how powerful a diagnostic tool the ultrasound scanner is and how fascinating sonography is in general. (I've written before about how I learned about the field of sonography and how much I like using acoustic energy for diagnoses--see my previous blog entry The Amazing Diversity of Acoustic Energy.)

During these presentations, I explain to the students that performing sonographic exams is like playing detective in a video game but we get paid for it and we are helping people get well too---how cool is that?

A few years ago I received an AIUM Endowment for Education and Research (EER) grant for a project entitled "Enhancing Awareness of the Diagnostic Medical Sonography Professions: A High School Outreach Program." As part of that grant I agreed to create a PowerPoint presentation that I would provide to others free of charge so that they could offer similar presentations to students in schools near them. I am getting close to finalizing the presentation and hope to share it with anyone who is interested. I'll keep you posted on those developments.

In the mean time, if you want to have some fun and educate students in your area about the field of sonography, I would strongly encourage you to consider contacting the school's guidance counselors or science teachers and offer to visit them. You can provide a formal presentation like I do or just bring a portable scanner and provide a live demonstration. Either way, the kids will love it and I'll wager that you will too. If you'd like some suggestions on how to get something like this started in your area, please feel free to drop me an email. Conversely, if you've done something like this already, please consider sharing your experiences with us in a comment added to this bog.

Something for Everyone at the Leading Edge

Daniel Merton — Tue, 27 May 2008 15:42:00 GMT

Last week the Jefferson Ultrasound Research and Education Institute (my employer) held it's annual Leading Edge in Diagnostic Ultrasound conference in Atlantic City, NJ. This was the 28^th annual meeting and I felt very much like a "seasoned alumni" (read: old) since I've been to this meeting for the last 25 years. The meeting director, Dr. Barry B. Goldberg, and his co-directors deserve a lot of credit for once again putting together a meeting that offered educational opportunities for virtually anyone in the field of sonography--from students preparing to take their certification examinations to researchers and, of course, clinicians from many disciplines.

I am sure you will be seeing an article soon either in print and/or on-line from Stacy Stanislaw, Assistant Editor at ADVANCE for Imaging and Radiation Therapy Professionals, but I wanted to share with you my personal take on this year's LE meeting.

The one-day Physics Refresher (part of a 3-day "The Requisites" track) was well attended and, for a change, there were not only younger students in the crowd but also more mature attendees. I suspected they were new users of sonography from the "emerging markets" of rheumatology, anesthesiology or sports medicine who wanted to obtain a foundation of physical principles of the modality. The Physics Refresher was taught by Dr. Fred Kremkau, one of the most well-known PhDs in the field. I had lunch with Dr. Kremkau and he mentioned that he is looking forward to publishing the eighth edition of his highly regarded book Diagnostic Ultrasound: Principles and Instruments.

The "Women's Imaging Symposium" offered a one-day session on breast sonography as well as lectures covering both obstetrics and gynecology. There was also a half-day "Fetal Nuchal Translucency Credentialing Course."

The 3-day track entitled "Vascular Ultrasound Head to Toe" had (as the name suggests) presentations that included cerebrovascular, peripheral and visceral applications of Doppler ultrasound. The vascular themed lectures are always popular since this is a dynamic area of sonography because the applications continue to expand and improve with advances in technology.

Musculoskeletal sonography continues to gain attention both within as well as outside of radiology. At this year's conference there was a 2-day seminar that covered upper and lower extremity applications. (Who said you can't evaluate the knee with sonography?!) The meeting room was standing-room only, which suggests to me that there will be more practices offering MSK US services in the future.

For the researchers in attendance, there was the 14^th annual "Contrast Agents Symposium" (which, unfortunately did not attract a huge crowd most likely because of the recent problems that contrast agents have had in this country) and an "Elastography Tutorial" that was surprisingly popular. Elastography is gaining a lot of attention these days, and I believe it represents a new frontier for engineers, scientists and clinician researchers to collaborate towards improving ultrasound diagnoses.

Next year the Leading Edge will be held May 19^th - 22^nd in Atlantic City, NJ. You can get more information from the JUREI website; www.jefferson.edu/jurei/

I hope to see you there.

Bubbles are Back!

Daniel Merton — Fri, 16 May 2008 12:41:00 GMT

A change in the labeling of Definity and Optison is the direct result of concerted efforts by the echocardiology community.

Chalk one up for the good guys! In a rare move, the United States Food and Drug Administration (FDA) has agreed to relax its warning about the possible risks of the two commercially available ultrasound contrast agents, Definity and Optison. In October, 2007 the FDA required the agents to carry a "Black Box Warning" which placed significant restrictions on the use of the agents. Many members of the ultrasound community, particularly cardiologists, questioned the validity of the FDA's decision and felt that the restrictions were not warranted.

Thus, a concerted movement was initiated to objectively assess the safety of contrast. One study, which was presented at this year's meeting of the American College of Cardiology, compared the outcomes of patients who received contrast-enhanced echocardiography studies to patients who did not need to receive contrast. Of the nearly 18,000 individuals who received contrast injections, none experienced an adverse event within 30 minutes. Another compelling report was published in the March issue of the Journal of the American College of Cardiology: "Acute Mortality in Hospitalized Patients Undergoing Echocardiography With and Without an Ultrasound Contrast Agent".

Although the product's package inserts will still have black box warnings, the FDA has eliminated a ban on giving the agents to acutely ill patients, such as those with congestive heart failure (many of which are the very patients that need contrast-echocardiography studies the most). The Feds also changed the requirements for monitoring patients that receive contrast. The previous warning had called for monitoring all patients for 30 minutes after they received contrast, but the new warning only requires monitoring of patients with pulmonary hypertension or unstable cardiopulmonary disease.

The cardiology community should be applauded for their successful efforts to convince the FDA to relax its restrictions. Furthermore, the FDA should be praised for its willingness to right a wrong. Both of these actions will now allow cardiology professionals to resume performing contrast-echocardiograms and enhance (pun intended) the care of cardiac patients.

Lantheus Medical Imaging is the distributor of Definity. Read more about the FDA's labeling requirement here: Lantheus Medical Imaging, Inc.,

Minimally Trained but Maximally Utilized

Daniel Merton — Tue, 13 May 2008 20:18:00 GMT

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.

A New Electronic Leash

Daniel Merton — Tue, 29 Apr 2008 14:56:00 GMT

Remember the days when the sonographer could go off on portables (toting a bundle of film cassettes) taking their own sweet time to wander around the hospital, do a few cases in the intensive care units, chat with the floor nurses and colleagues they met in the hallway or admire the view from the top floor of the hospital (at least that's what I've heard other people did...).

Then came healthcare reform and budget cuts, which forced all of us to do more with less staff, not to mention the dreaded pagers the schedulers could use to track us down and tell us there was another portable case added on. Those pagers were the first generation of "electronic leashes" that could yank us back to our responsibilities.

Later, cell phones were implemented to summon the stray sonographer. Fortunately, caller ID allowed us to choose which calls we decided to answer, but by and large the cell phone enhanced communication between the base station (sonography lab) and the roaming professionals both within as well as outside the hospital setting (e.g., on-call).

Now, there are new tracking tools, and the damn things are turning our very own beloved technology against us!

They're called ultrasound positioning systems. These tracking devices can be utilized in hospitals to monitor the locations, in real-time, of patients (so the nursing station would know when Mr. Jones is on his way back to the unit) as well as medical equipment (i.e., ultrasound scanners being used for portable procedures). Obviously they have other uses outside of medicine too.

The Sonitor system uses wireless detectors and "tags" that are linked to a digital file containing all vital statistics and information about the device or person being monitored. The tag uses ultrasound waves to transmit a unique identification signal to detector. The detectors transmit signals over an existing local area network (LAN) to a central computer that stores the information about the tag's location and the time of receipt of the signal. The system is reported to be 100 percent reliable in its ability to track the location of equipment and people (patients or professionals).

Oh well, no more lally-gagging when you're out on those portables. But just think of how useful a tracking system like this could be to monitor where your teenagers are going and how long they spend at the party on a Saturday night!

See why ultrasound is used and how theses systems can be utilized in a hospital environment here: Why Ultrasound for Indoor Positioning Systems?

The AIUM's EER Issues an RFP to Help Professionals Help Patients

Daniel Merton — Thu, 17 Apr 2008 19:50:00 GMT

As sonographers and vascular technologists, it is in our interest for the medical community (as well as the general public) to recognize the benefits of our examinations. This includes the potential and real benefits diagnostic sonography offers as compared to other more costly imaging modalities such as CT or MRI and/or modalities that utilize ionizing radiation like X-ray, nuclear medicine and angiography.

Thus, I was very happy to learn that the American Institute of Ultrasound in Medicine's Endowment for Education and Research (EER) has issued a Request for Proposals (RFP) for investigations into the costs, accuracy, risks and benefits of sonography compared to other imaging modalities. This is, to my knowledge, the first targeted initiative that the EER has ever undertaken.

In case you are not familiar with the EER, it is an AIUM member-funded endowment designed to support critical research in the field of ultrasound imaging. According to the AIUM's web site, "The fund provides investigators from all disciplines of diagnostic ultrasound with an opportunity to further their professional development and secure the most promising future for ultrasound in medicine."

Each year the EER awards up to $10,000 to four individual projects. Since its inception in 2001, nearly $300,000 has been awarded by the EER for ultrasound education and research.

The new EER RFP is called "Study of Ultrasound Compared to Other Imaging Modalities," and has a deadline for submissions of July 1, 2008.

For this special project, the EER will award up to $50,000 for investigators to evaluate the costs, accuracy, risks and benefits of ultrasound compared to other imaging modalities. Proposals are expected to address decision analyses regarding a specific disease entity, body region or patient symptom. In addition to the potential cost benefits of sonography, radiation exposure (or lack there of) can also be addressed.

Basically, the purpose of the EER's RFP is to encourage investigators to evaluate and uncover the potential costs and/or safety benefits of sonography for use in initial evaluations or follow-up of patients with specific indications.

Examples of possible projects would be:

To compare the use of ultrasound-guided breast biopsies to needle localizations using mammography.
To compare the use of musculoskeletal sonography to MRI for rotator cuff tears.
To determine if intra-operative ultrasound imaging can reduce the need for pre-operative CT for patients with liver metastases.

The results of projects such as these will not only demonstrate how sonography can be employed more cost effectively, but also to expand the use of the modality to the point that its use becomes the standard of care. When and if that happens it will enhance sonography's standing as a diagnostic modality, save valuable healthcare funds and ultimately improve patient care. After all, that's what it's really all about.

More information including a list of criteria and submission forms can be found on the AIUM's EER website.

[Full Disclosure: I received an EER award in 2006 for my project "Enhancing Awareness of the Diagnostic Medical Sonography Professions: A High School Outreach Program." I am also a member of the AIUM's EER Committee and am on the AIUM Board of Governors.]

CARE Bill is Making Progress

Daniel Merton — Fri, 04 Apr 2008 13:03:00 GMT

The Society of Diagnostic Medical Sonography recently announced that the "Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy" (CARE bill; Senate 1042) recently passed the Senate Health, Education, Labor and Pension (HELP) Committee. This step is an important milestone in the SDMS' effort to pass this major legislation.

The specific wording of the CARE bill states:

"To amend the Public Health Service Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly."

I have written before about the CARE bill in a previous blog. According to recent SDMS news release, the Senate Finance Committee has expressed interest in the bill's provisions because of the potential cost savings from a reduction in repeated studies. The bill is expected to not only reduce the cost of medical services by reducing the number of repeat examinations, but it is also expected to require credentialing and education standards for sonographers and other imaging professionals.

Thus, it would likely improve the overall quality of care. That can only mean good things for patients, as well for as those sonography providers who are fulfilling their roles in terms of delivering high-quality patient care. Meanwhile, those providers doing sub-standard services may be looking at problems down the road. I'll keep you updated as the CARE Bill advances through the oh-so-sluggish legal process.

Click here to read more details about the CARE bill.

A Valuable Web-based Tool For Us All

Daniel Merton — Mon, 31 Mar 2008 14:11:00 GMT

Several years ago the topic of one of my ADVANCE for Imaging and Radiation Therapy Professionals articles was a hypothetical "eBay for Healthcare." In that column I described how potentially useful a feedback feature would be for patients to be able to learn about how previous patients were treated by a particular healthcare facility or provider.

Here is a snippet of what I wrote:

One of the most useful aspects of the auction site... is the "feedback" section. Here, buyers and sellers can indicate, in 80 characters or less, their experience with a deal. For example, sellers can indicate how quickly the payment was received and buyers can indicate if the item was accurately described in the listing. Also, before placing a bid on an item, prospective bidders can review the seller's feedback left by previous buyers to determine if the seller has a good or bad track record. ... The feedback component contributes to each party being held accountable for their actions on the auction site.

Well, it appears that the hypothetical scenario I described back in 2003 has become a reality. The federal government recently launched the Hospital Compare Website where patients can describe their hospital experiences and read about the experiences of others. The site is designed to help patients compare the quality of care hospitals provide and empower them to make educated decisions.

There are several useful sections on the site, including a survey results section where patients can read what other patients say about the care they received in a hospital. There are also dedicated sections that describe patients' rights and a "Hospital Checklist" that includes questions that prospective patients should consider before they go to the hospital. Other areas provide information that hospitals voluntarily submit from their own medical records about the treatments their patients received. You can search for and compare hospitals based on certain conditions or procedures, as well as by geographical locations.

Hospital Compare was created through the efforts of the Centers for Medicare & Medicaid Services (CMS) and the Hospital Quality Alliance (HQA). It includes data that was collected by hospitals from a random sample of patients between October 2006 and June 2007. The amount of data provided is quite impressive, and it can take some time to navigate through it all to in order to get the answers you are seeking. This isn't surprising given that the site was developed by the federal government (if you've ever tried to obtain information about government grants or visited other ".gov" sites you'll know what I mean).

While I would like to take credit for coming up with the concept of such a patient-advocate site (do you think some CMS bureaucrat read my eBay article in ‘03?), I suspect it was born as a logical and worthwhile tool to allow the public to determine how well a particular hospital is doing and to enable them to make educated healthcare choices.

An obvious additional benefit to us all (as former or future patients) is that hospitals will need to constantly improve their quality of care or risk receiving "bad feedback" and lose both their reputation within the community as well as future patients' business. I would encourage you to take a look at the website--if not now--then definitely when you or a loved one needs to choose a hospital.

Personal Laptop or Sonography Scanner?

Daniel Merton — Wed, 26 Mar 2008 16:41:00 GMT

"Simply attach the probe to your laptop computer using a standard USB cable, install the software and you're ready to scan."

That's the latest approach to providing highly affordable sonography scanners; ones that convert any personal laptop into a diagnostic sonography system by having all the necessary hardware in the probe itself. The hardware, which is supplied with the required software and usually operates on any PC, only costs a few thousand dollars.

The concept of the personal laptop computer-based scanner dates back to the year 2000, when Terason introduced its first commercially available system utilizing "ultrasound-system-on-a-chip" technology. Since then, thousands of their scanners have been shipped throughout the world.

More recently, an Apple MacBook Pro laptop has been the foundation for Siemens Medical Solutions' own version of the ultra-portable, battery-operated scanner. The Acuson P50, as its called, has a number of proprietary echocardiography and vascular calculation capabilities as well as an integrated stress echo package. Thus, the system can be used for not only the usual diagnostic exams but even for more advanced applications, which would make it attractive to a wide range of users. However, the P50's ultrasound hardware cannot be removed from the laptop, which makes the overall size of the system significantly larger and more expensive than a standard laptop system.

The latest versions are virtually indistinguishable from your run-of-the mill laptop computer (except for the transducer attached via the USB port) and a lot less expensive than previous versions. The systems don't require any super-computer capabilities. In fact, I've heard that, in some cases, any device that has a USB port can be used as a scanner.

There are probes for all typical sonography applications including vascular, echo, abdominal, endovaginal and endorectal scanning, as well as probes with biopsy guidance capabilities. Units that are currently available have all the usual modes of operation and other features you expect to find on a diagnostic scanner, including color and spectral Doppler, tissue harmonics, calculation packages and memory for image storage.

The obvious advantages to these are that you can choose to use your laptop for all the usual reasons (ie, word processing, Web browsing, emails, presentations, etc) and, when necessary, plug in the transducer and scan away.

Of course, this does raise some concerns over who will have access to the technology. However, aside from the relative low-cost of this approach, this isn't necessarily any worse than what's happening with other hand-carried scanners or even the 4D ultrasound units used for keepsake purposes. It will remain to be seen how the FDA regulates the sale of these systems.

There are several manufacturers producing this type of equipment. For more information, click on any of the links listed below.

MUSL Laboratories

Ardent Sound, Inc.

Direct Medical Systems

Laborie Medical Technologies