Handheld Ultrasound, Didactics and Bootstrapping

A few months back, GE announced their first handheld ultrasound device, the Vscan. It’s developed by GE Vingmed in Horten, by a team lead by Kjell Kristoffersen. For a more thorough background, check out TU (Norwegian only).

The device looks rather slick, and transports pretty easily. The estimated sales price is said to be around $10,000, which puts it at the lower end of the price spectrum for ultrasound machines. It’s not expected to be as capable as some of its bigger cousins — in part due to smaller and different transducers, from what I can gather. Even so, I suspect the device will eventually end up in doctors’ pockets all over the well-to-do world, because at the surface, it presents such an appealing proposition.

While working in the ER, I’ve often had the desire to have a quick sneak peek into a patient’s abdomen looking for pathological fluids, or into soft tissue when trying to remove foreign objects (you’d be surprised how deep splinters from even the most harmless of materials can actually penetrate, given enough force). I suspect that using the handheld ultrasound for simple things like these, is something that most doctors can learn rather easily. However, interpreting ultrasound images in general, requires a bunch of training and experience.

The need for such training has been foreshadowed for a while. I remember a couple of years ago, when the radiologists and the gastroenterologists talked warmly about the upcoming handheld ultrasound, and how every junior doctor would walk around with one in their pocket. Now that technology is finally here, but training isn’t — yet.

The rapid introduction of new, handy and comparatively cheap technologies like the handheld ultrasound is somewhat of a double-edged sword — it will help shed light when wielded by expert hands, but only serve to confuse the untrained. (This is a general statement, of course, not specific to the field of medicine.) The simple and obvious solution is to train young doctors, possibly still in medical school, to wield these effectively, and to provide suitable courses to existing practitioners. But training takes time. Medical school is only 6 years (Europe). If you add ultrasound to the curriculum, you must throw something else away. The same for existing practitioners — they must stop working at the factory (hospital) when training, or not train other (people?) skills.

Medicine is a field with constant information overload, and the overload is increasing every year. One of the major impediments to progress — in terms of deploying new, improved ways to diagnose and treat illness — isn’t the lack of new technology, but the cost and time of training existing practitioners.

It would seem that we’re touching some of the issues Doug Engelbart bumped into with his Bootstrapping Strategy: We need to improve the way we improve. I share Engelbart’s belief that one crucial ingredient for this improvement comes through technology — even though I don’t have the answers as to exactly how yet:)

Some specific and well-tested technological solutions could be (for computer-driven devices): The devices could come with training programs built-in, and possibly even self-evaluation tests. Bundling a couple of well-choreographed training videos on devices with video screens would be trivial. Even showing procedures, with diagnostic criterias (where available), would be highly useful, too. Consider these refreshers. The initial ultrasound course + rubber stamping of proficiency only lasts so long if you don’t practice regularly.

Mind you, the issue of training isn’t really a problem for the expert who will be using the machine for performing a diagnostic procedure every day — such users will learn the ins and outs quickly enough. These are the specialists who find it worthwhile to lug around the big ultrasounds. New machines won’t replace them. The training issue is a problem for the other users, those who want to have a access to a small part of the repertoire of a specialist, from their own pocket. For these users, it’s important that obtaining sufficient training and knowledge is trivial, so that new machines improve, not deteriorate, the overall level of healthcare.