Radiologist's study supports the use of portable ultrasound in developing countries

Of all the current imaging techniques, portable ultrasound has shown the greatest promise in meeting the needs in developing countries such as Ghana because it is transportable, relatively inexpensive and has a wide range of applications. This conclusion is based on a study to be published in the December 2008 issue of the Journal of Ultrasound in Medicine.

In many developing countries, access to medical imaging is limited by the availability of economic resources and expertise in performing and interpreting these images, as well as the skilled labor necessary to maintain the equipment.

In March 2004, Dr. Ronald Adler, chief, Division of Ultrasound and Body CT, Hospital for Special Surgery Department of Radiology and Imaging, explored the use of ultrasound in primary care and hospital settings at the Ghana Health Mission clinic in Sekondi-Takoradi, Ghana, West Africa. The objective was to evaluate the functionality of a portable ultrasound machine and its clinical usefulness in a variety of physical conditions and across multiple clinical scenarios. Jacqueline K. Spencer, M.D., MPH, director of Primary and Ambulatory Care, VA Boston Healthcare System, was a co-investigator in the study.

Ultrasounds were performed at two primary care sites, one in an urban setting and the other in a rural village, and two hospitals, one regional and the other a local hospital, where referrals were made by clinicians. The majority of ultrasounds were performed for musculoskeletal complaints with the remainder for obstetrical, pelvic, breast, vascular, abdominal and genitourinary (GU) examinations.

The authors found that in clinic settings, musculoskeletal ultrasound represented 46 percent (16) of the ultrasounds performed and 29 percent (10) of the cases were a combination of abdominal, pelvic and GU ultrasounds. Whereas in the hospital settings, abdominal, pelvic and GU ultrasounds combined were 56 percent (18) and musculoskeletal was 41 percent (13). Of the 67 ultrasounds performed, 81 percent (54) were found to be abnormal, 81 percent (54) were considered to add to the clinical diagnosis and 40 percent (27) influenced the outcome of medical care for the patient.

"It was readily apparent that the small, portable ultrasound units could play an extremely valuable role in developing countries," said Dr. Adler. "The challenges to effectively instituting this form of imaging will depend on proper training to ensure the appropriate referral of patients who will clearly benefit from such imaging, adequately trained medical personnel to operate the equipment, interpretation of the images and exploration of collaborative efforts with outside organizations or institutions that can assist with these training needs and financial requirements."

The economic limitations of many countries often means that the cost of a small portable ultrasound machine remains out of reach, noted Dr. Adler, but they are less expensive than CT scanners and MRIs. The former typically costs $25,000 to $50,000 compared to millions of dollars for the full-sized units.

Editor's Note: All examinations were performed using a Logiqbook scanner (GE Medical Systems, Milwaukee, Wisc.) and intermediate linear and/or curved linear phased array transducer.

Hospital for Special Surgery (HSS) Department of Radiology and Imaging has the largest and most experienced academic musculoskeletal radiology faculty in the world, each with academic appointments at Weill Medical College of Cornell University. HSS Radiologists are board-certified by the American Board of Radiology and have received numerous awards by honor and professional societies, including the Consumer's Research Council of America Guide to America's Top Radiologists. The Department's focus is diagnosis of musculoskeletal conditions and diseases and their treatment utilizing image guidance. More than 200,000 musculoskeletal examinations are performed annually, of which approximately 150,000 exams are conventional radiography, 24,000 are Magnetic Resonance (MR), and 12,000 are Ultrasound (US). Other imaging includes Computed Tomography (CT), Nuclear Medicine (NM), and Teleradiology. All imaging in the Department is acquired digitally.

HSS Radiologists are committed to excellence and under the direction of Dr. Helene Pavlov, Radiologist-in-Chief, emphasize that diagnosis depends on quality image acquisition and "All images and imaging are not created equal." For more information on the Department of Radiology and Imaging at Hospital for Special Surgery, contact 212-606-1132 or send an email to info@imaging.hss.edu.

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology and rehabilitation. HSS is nationally ranked as No. 1 in orthopaedics, No. 4 in rheumatology by U.S.News & World Report, and received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. A member of the New York-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopaedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All HSS medical staff are on the faculty of Weill Cornell Medical College. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

For media contact only:
Phyllis Fisher
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Michael Volpatt
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