Crystal Ball: Ultrasound in 2015

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Tonight I stopped by a session on where ultrasound will be in 2015, kicked off by John Cronan, MD, with these heartening words: “This topic hasn’t gotten any cleaner, and in fact, I think it’s gotten more complicated. The issue of radiation has made it more complex. My prediction is that ultrasound in 2015 will be doing great, but imaging’s control of it will be less than it is today.” Cronan pointed out that everybody thinks they can do ultrasound. With the radiology job market tightening up in anticipation of health care reform and a “very skewed payment system” that only rewards MR and CT, the ideal job for residents is one where they walk out and practice MSK radiology Monday to Friday from 8:30-5. “The development in imaging for the past ten years has only been in MR and CT,” Cronan said. “The only advance in ultrasound technology has really been miniaturization.” In 2004, the AMA issued a statement saying anyone with an MD could practice ultrasound. But they also stated that every specialty should set its own standards. “Let everybody set their own benchmark, essentially,” he said. “General medicine sees ultrasound as the venue for everybody.” Radiologists have essentially let ultrasound slip while defending their turf in the CT world, Cronan argued. While they’ve been focusing on high-end procedures, ultrasound has slowly but surely crept into the domain of other specialties. “Most radiologists, our compact ultrasound units sit in the corner. We don’t think their good enough,” he said. “Others, however, have embraced them.” Few residents want to go into ultrasound. Many training programs lack ultrasound experts. And PACS, teleradiology and the web have helped change imaging into a commodity, moving diagnostic evaluation outside the control of radiologists. In other words, it’s the perfect storm, Cronan said: “The world has embraced ultrasound as the new stethoscope.” So where’s the future? Cronan thinks ultrasound is diffusing into medicine the same way other imaging is. “It’s less of a frontline tool for radiologists,” he said. “We don’t embrace it as the frontline, but other people do.” He argued that compact ultrasound was the Trojan Horse that got everybody into the game. “When ultrasound units cost $200,000, that was a barrier in itself,” he said. “Now that the prices are down, it truly is the stethoscope of the future.” Although radiologists are dependent on technology and identified with it, they oppose some new technologies – compact US, small-bore MRI – because they’re disruptive. “We’ve been Luddites in terms of our opposition to miniaturized ultrasound,” he said. “If you’re looking for purposeful exams, where you just want to answer a specific question, you can answer it with these devices.” But what’s best for patient care? Well, as Cronan points out, life is pretty sweet for radiologists as it is. “I think in the real world, ultrasound is a tool that belongs to many specialties,” he said. “If we’re going to try to fight that, we have a very difficult task ahead of us.”