While the size of ultrasound systems is shrinking, the magnitude of the medical imaging tool is soaring to newer heights, literally. Developers have made significant improvements in the image quality, portability, dependability and durability of these lightweight "hand-held" systems so that now they can expand beyond the perimeters of traditional ultrasound settings into arenas such as emergency medicine, internal medicine, interventional, musculoskeletal, small parts, and surgery. They are also accompanying training programs overseas, research projects to distant locations and healthcare expeditions to underserved communities. Within hospitals, imaging centers and clinics, compact ultrasound systems are becoming cost-effective and time saving alternatives to high-end systems at the point of patient care.
When the August 2003 North East Blackout struck communities spanning from New York to Chicago, Dave Homa, a cardiac sonographer at Cleveland Clinic's Cardiovascular Imaging Department in Ohio, was just about to perform an echocardiogram on a patient to access left ventricular systolic function. Despite the power outage, Homa completed the exam using a battery operated compact cardiovascular ultrasound unit. Identifying an ascending aortic dissection, Homa immediately contacted a cardiologist and a cardiac surgeon and the patient was rushed to cardiac surgery for treatment.
Batteries are not the only feature of a compact ultrasound system, such as the Siemens Medical Solutions' Acuson Cypress used by Homa. The miniature devices typically weigh less than 10 pounds - compared with their 400 pound, high-end cousins; are low-cost alternative replacements for upscale models (hand-held units range from $15,000 to $30,000, while premium systems fall in the range of $150,000 to $160,000); provide high-quality images; and feature a range of sophisticated imaging techniques.
"I think that [the compact system] brings an economical solution and it brings a capability of doing easier portable studies at the bedside," says Mario Garcia, MD, director of the Cleveland Clinic Cardiovascular Lab. One way in particular is to gather anatomical and functional information of the cardiovascular system in patients after surgery. "If we are doing ultrasound on patients who are being discharged from the hospital after a valve procedure and we don't have to primarily look for pericardial perfusion, or assess mitral and aortic valve abnormalities, the portable device is a good system," explains Garcia.
In addition to surface echos at the bedside, the device is utilized for transesophageal studies in the OR and ICU as well as utilized by interventional cardiologists and in electrophysiology to perform inter-cardiac studies. "The systems are very comparable with pretty much state-of-the-art ultrasound systems that are available right now," concedes Garcia.
They are also extremely durable. A team of researchers from the University of Giessen in Germany used the Cypress on an expedition to the top of Mount Everest in 2003 to investigate changes in cardiac performance and lung function. The team wanted to evaluate the effectiveness of suitable interventions for pulmonary hypertension.
REACHING NEW USERS
Compact ultrasound units are by no means limited to cardiology. GE Healthcare offers the Logiq Book that is intended for abdominal, vascular, obstetrics, gynecology, neonatal, urology and small parts studies. The system resembles a laptop computer with a 10.3-inch, high-resolution color LCD (liquid crystal display), weighs 10 pounds and features networking and wireless capabilities.
"Compact ultrasound is growing relatively fast," says Jeff Peiffer, manager of compact ultrasound for GE. "It is the first time that we have technology that can actually be put in a portable package. There has also been a growing need to bring imaging to the point of patient care. The other part of that is there is a tremendous growth in the merging of diagnostic imaging and therapy. As these lines become more and more blurred, [compact] ultrasound is a great tool to be used for guidance - not only in diagnosis, but for biopsy guidance or catheters."
Radiology, cardiology and ob/gyn are the traditional settings for compact ultrasound, but Peiffer notes that the systems are expanding to a host of users that include emergency room physicians, vascular surgeons, breast surgeons, orthopedists, rheumatologists and endocrinologists.
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