The Handheld Ultrasound Revolution

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Physicians can now pinpoint patient anatomy faster by performing an exam to assess cardiac function or detect arrhythmias right at the patient’s bedside.
Source: GE Healthcare
Handheld ultrasound devices have become a game changer due to their ability to facilitate rapid diagnoses and make imaging more accessible and immediate. Their pocket-size and low price tag puts them at physicians' fingertips, which could help explain why these devices saw a 21 percent surge in sales in 2010, according to "The U.S. Market for Compact Ultrasound Systems: Challenges & Opportunities—2010," a report issued by Klein Biomedical Consultants of New York City. However, despite soaring sales and clinical enthusiasm, there are still unsettled issues including reimbursement, the potential for overuse and decreased exam comprehensiveness.

Handheld: The new stethoscope?

"These devices are a revolution in miniaturization," offers Barry B. Goldberg, MD, director of the Jefferson Ultrasound Research and Education Institute at Thomas Jefferson University Hospital in Philadelphia.

And while handheld systems allow physicians to perform real-time imaging exams at pint-sized prices ($8,000 vs. as much as $250,000 for full-sized systems), there are trade-offs in terms of exam comprehensiveness and image quality. Handheld devices may weigh less than two pounds and have display screens that measure 3.5 inches with a 240x320 pixel resolution, which means some more intricate diagnoses—such as kidney obstruction—may not be feasible because the devices cannot perform additional measurements and look at other anatomy like the liver or spleen.

Another pitfall of these pocket-sized systems is difficulty archiving images, says Christopher L. Moore, assistant professor, department of emergency medicine at the Yale University School of Medicine in New Haven, Conn.

Because most handheld systems do not yet have wireless connectivity, physicians can't archive images directly to PACS or input patient information. "To permanently archive these images, you must match the patient name with the number of the image. This process is prone to error," explains Moore.

As handheld use becomes more widespread, there also is potential for overuse, adds Jonathan W. Berlin, MD, clinical associate professor of radiology at the University of Chicago Pritzker School of Medicine. Overuse can lead to greater aggregate cost and "will increase the need for more vigorous quality assurance," continues Berlin.

Reimbursement: Great unknown

The million dollar question that remains is: will physicians be reimbursed for less comprehensive exams?

"All of a sudden physicians are doing hundreds of ultrasound exams. There is only so much money in the pot, so if you are using this like a stethoscope, I anticipate that the government will no longer cover these very basic, quick exams," Goldberg predicts.

Currently, reimbursement varies on a state-by-state basis. While some third-party payors cover quick scans, others will only cover more comprehensive ultrasound exams performed by larger, cart-based systems.

In addition, handheld devices are meant to look at a single problem, but if a physician finds a lesion, a more comprehensive exam would be necessary and the physician would be less likely to be paid for the handheld exam, says Berlin.

As the market expands, will handheld systems find their place? There has been a boom in sales, greater accessibility and a spike in imaging. Berlin, however, ends with a caveat. "These devices are powerful technology so there must be a balance between making sure people know how to use them and not restricting use, which could be a tough balance to find."