Dr. McGahan is a Professor of Radiology and the Director of
Abdominal Imaging and Ultrasound at the University of
California Davis Medical Center, Sacramento, CA. He is also a
member of the editorial board of this journal.
The practice of ultrasound differs greatly when viewed from a
worldwide perspective. Without a doubt, sonography is the most
utilized cross-sectional imaging device in medicine. The growth of
medical ultrasound continues to expand as applications for
ultrasound continue to grow. However, who performs and interprets
ultrasound exams is quite different from continent to continent,
country to country, and, at times, even city to city. In the United
States much of inpatient ultrasonography is performed by
radiologists, while much of the outpatient sonography is performed
by clinical specialists. In many countries, clinicians often
dominate the use of sonography.
Recently, a number of manufacturers have introduced newer,
smaller portable ultrasound units. While the resolution of these
units do not surpass that of the "high-end" ultrasound units, their
image quality is certainly on par with the images of the "best"
ultrasound units of a few years ago. Thus the question arises,
"Will ultrasound become the stethoscope of the future?" Will
clinicians use ultrasound in their day-to-day practice as they use
their stethoscopes? Will a patient who presents to a physician's
office or to the emergency room be examined for gallstones by the
clinician as part of their initial evaluation? Will, in fact,
clinicians of the future use ultrasound in a similar fashion as
Star Trek's Dr. McCoy did with his probe that scanned the patient?
What does all this mean to the radiology community?
Recently, at our institution we have seen tremendous growth in
performance of ultrasound in radiology. Sonography has become a
very cost-competitive imaging modality. Ultrasound is relatively
inexpensive, widely available, and can be performed in an expedient
fashion. These advantages of ultrasound will no doubt increase the
use of sonography, but the questions remain: will we have continued
growth of ultrasound performed by radiologists or will the pendulum
swing with radiologists losing this marvelous tool to our clinical
colleagues? The answer is not certain. I can only think a few years
back when predictions were made concerning the future manpower
needs in radiology. There were careful calculations, and then there
were warnings concerning the "glut" of radiologists in the
marketplace. In retrospect, it is easy to see how flawed these
predictions were. Likewise, it is probably impossible to predict
with any accuracy the future role of radiologists in performing and
interpreting ultrasounds.
Whether their role decreases, stagnates, or increases depends on
a number of different factors, some of which we can probably not
even take into consideration at this time. One of the factors
depends on the advances of ultrasound equipment and new and
different uses of sonography. No doubt there will be future
advances in ultrasound imaging. For instance, as contrast agents
become widely used in ultrasound, the use of contrast-enhanced
sonography by radiologists will probably increase. It is important
that radiologists thus continue their role in this and other areas
of ultrasound research. It is imperative that we take the lead in
this area to pioneer new and different uses for sonography.
Furthermore, our role in ultrasound education cannot diminish,
whether during residency or after training. It is also important
that we set high standards as radiologists.
The American College of Radiology has taken a leadership role in
setting standards in all facets of diagnostic imaging, including
sonography. Market factors and reimbursement patterns for
ultrasound may change in the future, which may be to the benefit or
the detriment of radiologists performing ultrasound. In any case,
it is hard to predict with any amount of certainty how
radiologists' roles in ultrasound will change in the future. There
is no doubt that currently there is an expanded use of ultrasound
in a number of different areas. It is imperative that we as
radiologists continue to learn about these new uses of sonography
to maintain our expertise in the field.