Many researchers are currently grappling with the practical and ethical implications of the miniaturisation of ultrasound equipment, for example. Equipped with a phased array transducer, machines like the GE Vscan can technically be used to perform a simplified echocardiogram. This has led to a fierce debate within the field as to what actually constitutes an echocardiogram in the first place.
- Is an echocardiogram defined by the operator – i.e. is an echo only an echo when performed by a fully qualified echocardiographer?
- Is an echocardiogram defined by the capabilities of the system – i.e. on ultrasound equipment capable of allowing the operator to quantify (taking measurements, using spectral Doppler, and so on)?
- A combination of both?
These are problems which bodies such as the European Society of Cardiology (ESC) and American Society of Echocardiography (ASE) have recently had to publish guidelines and position statements on, and agreement and terminology is far from universal, with some authors arguing that terms like “limited echocardiogram” should be used, and others rejecting the use of the word “echocardiogram” at all when applied to ultrasound systems with limited functionality.
The main problem seems to be in the interpretation of the data, and not so much in its collection. Numerous studies have demonstrated that ultrasound equipment can be placed in the hands of non-accredited individuals who are taught to perform only a limited number of views (a ‘focused echo’), which can then be interpreted by an expert later on or at a different location (telemedicine). This offers obvious advantages for helping people in remote parts of the world, who might otherwise not have access to cardiac scanning services.
It is the strong focus on interpretation rather than on data collection that allows echocardiographers to independently perform private scanning services, so long as their scans are interpreted and signed off by a cardiologist. Similarly, in the world of pet scanning, a non-veterinarian is legally permitted to perform an external scan of an animal (i.e. the scan may be performed by an “unskilled operator”), as long as this individual does not attempt to diagnose from it. This limits the applicability of this technology to pregnancy scanning, where there has been a recent growth in the number of lay scanners who can offer an “informed opinion” on pregnancy as long as they are careful not to present their findings as a veterinary diagnosis of any kind. However, the lack of regulation in this area is beginning to cause considerable problems for the reputation of this service. Unlike in the previous example of echocardiography, for example, there is absolutely no requirement for operators to have undergone any formal training at all, nor is there any monitoring of the quality of the equipment being used. It is for this reason that organisations like the Association of Animal Ultrasound have been recently founded, in an attempt to bring about an industry standard.
Ultrasound is, of course, only one example of a trend which is permeating almost every aspect of medical equipment and small devices. Highly accurate pulse oximeters and even simplified portable ECGs are now available in pocket-size, and at a fraction of the cost that they would have been only ten years ago. Issues of operation and interpretation remain, but the majority of users appear to be split into two types:
- Those using small devices to monitor their own sports performance (both resting HR / O2 saturation and under exertion), and hence not make a medical diagnosis of any kind
- Those using small devices to collect data about their medical condition – however, crucially, this data is almost always then shared with a health professional. The patient is often advised by their doctor to purchase a device such as a fingertip pulse oximeter (with the Contec CMS50DL being a favourite of many doctors), and the patient is not left to interpret the data on their own.
Clearly, in this specific application of miniaturised medical technology, the advantages to people are significant, and the costs very limited indeed.