I recently had the chance to attend the American Institute of Ultrasound in Medicine’s Ultrasound First Forum. This was held on November 12, 2012 in New York. In full disclosure I did attend as a representative of the AIUM as an invitee.
Members from different societies and groups attended this forum to discuss medical ultrasound and how it can be promoted as a first line diagnostic therapy when appropriate. The thought of ultrasound first is to use a dynamic imaging modality that has no ionizing radiation and can provide the diagnostic information in many cases.
The discussion focuses on using ultrasound rather CT scans or MRI in cases where appropriate. Examples were given of female pelvis pain where ultrasound was more diagnostically appropriate and informative then CT scanning. Musculoskeletal complaints that could be evaluated dynamically, more thoroughly, and with better resolution with ultrasound compared to the static MRI were also given. These discussions all had merits and we heard from medical organizations, patient advocacy groups, and practitioners about why ultrasound should be considered before some other imaging modalities.
I agree that we should consider ultrasound before other imaging modalities such as CT and MRI when appropriate and available. That is the key point that has to be kept in mind. When ultrasound is an appropriate test it should be considered first. It does not mean it always has to be the first test, but considered and if appropriate be the first test.
It also depends if you have the equipment and personnel to perform and interpret ultrasound in some of these situations. We are leaders in our areas of medical expertise; but there is a variability in ability and resources across the country and the world. Not every hospital in every corner of the world can provide ultrasound in all its myriad forms and applications. In some areas ultrasound may not be the best first choice due to limitations in equipment, skill, personnel or other factors.
While I am an ultrasound evangelist and firmly believe in the technology and its role in patient care I also do recognize that there can be limitations in making ultrasound first even when appropriate, at least for today.
Here are links to the Ultrasound First site with the Sound Judgement series from JUM and AIUM.
Here is the collection of the tweets using the #US1st hashtag during the forum.
PS: As a side note ultrasound guidance for vascular access was also discussed at the forum. The AIUM Practice Guideline on US guidance for vascular access is forthcoming, I was able to see a draft at the forum. If you have ultrasound and are performing an non-crash IJ there is no reason to not use ultrasound.