6 ms·

Could ultrasound replace the stethoscope?

• mitchbob 4y ago
  Archived: https://archive.ph/DQrMf https://archive.ph/DQrMf
• deleted 4y ago
  [deleted]
• aaron695 4y ago
  Cheap Ultrasound should have won the Tricorder X Prize, but they made the conditions impossibly stupid, literally Star Trek sadly - https://en.wikipedia.org/wiki/Tricorder_X_Prize https://en.wikipedia.org/wiki/Tricorder_X_Prize Ultrasound goes to other industries like helping the true poor with smallholder animal husbandry to the billion dollar construction industry. The sensors just need to be made cheap and attachable to cell phones.
  • JPLeRouzic 4y ago
    Was some of these competitors' design open sourced? Thanks!
• hulitu 4y ago
  > Could Ultrasound Replace the Stethoscope? Can a slicing machine replace a knive ? Yes but it is too heavy to carry around.
  • rscho 4y ago
    We've got pocket ultrasound machines, now. https://vscan.rocks/ https://vscan.rocks/ It's one instance among many of the same.
    • amelius 4y ago
      Interesting, where can I read the product reviews?
      • sergers 4y ago
        Clarius mobile ultrasound has been the news lately. https://clarius.com/reviews/ https://clarius.com/reviews/ They were also part of AMD' CES keynote on health with their chips. https://youtu.be/OMxU4BDIm4M?t=3831 https://youtu.be/OMxU4BDIm4M?t=3831 Great story highlighted how having mobile ultrasound has helped this rural community doctor
        • haldujai 4y ago
          Butterfly iQ is another one worth checking out and popular with my ER colleagues.
          • viraptor 4y ago
            Those are used in a local clinic. I'm told they're not as high resolution as other options, but good enough for GPs + doing occasional obs scans. They're happy with it. There was some annoyance about choosing the model - there's a separate lightning and usb-C version, but at least now that will be finally unified.
            • haldujai 4y ago
              Good to know, I don’t have personal experience with POCUS devices (radiologist). I think traditionally Butterfly was much cheaper than Clarius, and had better software assistance / AI for things like TGC sliders and gain. Looking at the Clarius offering now it seems much closer in pricing and they’ve improved their software package. Surprised to hear that they have separate USB-C and lightning offerings in 2022/2023, seems archaic.
          • amelius 4y ago
            > popular with my ER colleagues. In the western world, isn't it preferable if ultrasounds are left to specialists? I'm wondering if the use of cheap portable devices is part of a trend of improving healthcare, or just making it cheaper (or both).
    • n8henrie 4y ago
      Butterfly also pretty sweet
• Gatsky 4y ago
  TLDR: Yes. An inordinate amount of time is spent teaching auscultation (using a stethoscope) to doctors. The diagnostic performance isn’t that great even under ideal conditions. Having bedside ultrasound would really improve things for patients, and save money on unnecessary tests and treatments.
  • haldujai 4y ago
    Thats a very generous view on the current state of POCUS. I don't believe this has been studied yet but the % of patients who undergo POCUS in the ED (which is billed for) and leave without formal imaging in the radiology department (also billed for) is probably in the single digits. Irrespective of their findings, clinicians are not yet confident enough to discharge their patient on the basis of their negative POCUS nor are surgeons confident enough in the clinician skills to operate on positive POCUS findings (except FAST). Hopefully this will slowly improve over time, particularly if AI can play a role in procuring adequate images, but ultrasound is a hard skill to master (sonographers do this day in and day out, a lot more skillful than myself as a radiologist let alone a clinician with an underpowered POCUS). Conversely, there is a non-trivial amount of unnecessary imaging generated as a result of POCUS findings (perhaps most significantly for aortic dissection which is a high dose CT scan). Out of ~100 CT studies I've reported that come with the history 'dissection/intimal flap on POCUS' 0 have been positive, and had the clinician gone purely on the clinical picture + labs they would have probably not ordered the CT in most of these cases. Also ultrasound can't penetrate lungs.
    • unwind 4y ago
      Here, POCUS = point of care ultrasound.
      • philiplu 4y ago
        Thanks for that. So what does ED refer to? Emergency Department? Synonym for ER?
        • 4y ago
• haldujai 4y ago
  Ultrasound can't penetrate lungs (bags of gas) so probably not, you can see things like effusions, pneumothoraces, and maybe a peripheral consolidation. Regardless, the stethoscope has (for better or worse) already been replaced for a while, at least for in-hospital care at larger US/Canadian community/academic settings, by chest x-ray and/or the increasing straight jump to CT pulmonary angiography. The amount of patients with respiratory complaints presenting acutely that leave hospital without radiology department imaging is probably <10% today. Physical exam skills as a whole are dying, abdominal pain is similarly a straight jump to CT or US these days, often before a physical exam is even documented (was it even done?). Even more true for gynaecological concerns (not debating whether or not this more ethical, but it's very rare to see ER physicians perform a vaginal exam these days before ordering ultrasound). In terms of the utility of POCUS, the heterogeneity in training has been a barrier to adoption by clinicians in Canada (I imagine similarly in the US). While POCUS is performed by ER/internal medicine, patients are still being sent to radiology for formal imaging before definitive management takes place, even for more straightforward cases like gallstones and kidney stones. Presently, very few POCUS studies are formally uploaded to a patient's record in my current hospital (largest institution in Canada) although that is increasing and clinician competence at POCUS is slowly rising. The FAST exam in trauma settings is probably one of the only reliable POCUS uses at the moment, and echocardiography.
  • n8henrie 4y ago
    Was mostly with you until comments about FAST. What?! Only validated in shock, I'd say one of the least sensitive and least important tests we do for questionable reasons, since every trauma goes to the donut of truth anyway. I would say biliary, echo, ocular, peritonsillar, procedural (CVC, paracentesis, thora), soft tissue, early obstetric all highly reliable in my practice environment. Then again, our small department is almost all recently trained and we have very limited radiology options so we get a lot of practice.
    • haldujai 4y ago
      I’m impressed by your comfort level and curious about the specific indications you’re doing, would appreciate your perspective as I’m in a tertiary care/level 1 centre so POCUS practitioners aren’t as skilled here imo. The training in Canada is also very heterogeneous (some do a 1 year fellowship while others do a weekend course with standardized patients). One of the issues to keep in mind with POCUS is monitoring outcomes / comparing with gold standards (whether that’s formal imaging or operative reports). In radiology we very often get feedback in addition to M&M + multidisciplinary rounds to maintain quality, anecdotally I’ve found this to be more variable in POCUS-heavy practices. 1. Regarding FAST There is a certain amount of variation by centre, but it is definitely not true that every trauma goes to CT first, most do but it’s not infrequent (forgive my usage of this) to go straight to OR for damage control lap and CT after, particularly with penetrating trauma or non-responding hemodynamically unstable patients. At my hospital (level 1 trauma) a positive FAST + instability generally goes straight to OR, you may argue the FAST is noncontributory and these patients should go straight to OR anyway but it’s certainly routinely performed. 2. Procedural - completely agree, should be highly reliable for all physicians. It’s arguably malpractice to do procedures blind these days. 3. Early OB - are you performing TVUS? This is uncommon, and if you are that’s phenomenal. Are you just doing r/o ectopic or formal dating US? CRL and MSD can be challenging to measure accurately, but if you’re doing a lot and getting followup from rads/OB it’s certainly possible to be reliable at this. 4. Soft tissue - as in abscess or MSK? MSK ultrasound is very challenging and I would be enormously impressed if you are doing tendon tears reliably (other than full thickness) as many radiologists are uncomfortable with these today. Do you have MR or formal radiology follow up reads to assess your sens/spec? 5. Biliary - Assuming you mean cholecystitis and gross bil dil, glad to hear this is becoming comfortable for POCUS practitioners. My centre has a formal POCUS fellowship but the surgeons don’t rely on their reads, they will see in consult based on POCUS but always demand a radiology examination prior to operating. I hope that this will change in the near future for chole. I’d be hesitant as a patient getting scanned for focal bil dil (aka ?cholangio) or PSC by POCUS, but I doubt that’s a common indication for you. 6. Echo - Assuming you mean for ER indications? Are you still sending for formal echos or comfortable ruling out all valvular disease? Our cardiology fellows who do bedside echo in CCU still seem to get formal reads. 7. Peritonsillar - I can’t even remember the last time I’ve reported one of these, we have dedicated ER CT scanners 24/7 so they always go straight to CT. Is this an accurate test? Overall happy to hear POCUS is more reliable in some places, I dream of the day I can stop reporting acute care US.
• l- 4y ago
  Absolutely! A tool for looking at the chest does not compare when the case calls for a stethophone.
• KaiserPro 4y ago
  no. Not until a ultrasound can easily and quickly identify a heart murmur or crackle of lungs indicating the type of lung infection. (as in put it on, wait for 10 seconds) Look, ultrasounds are slow, narrow, high resolution tools. Scanning your lungs with an ultrasound takes a fucking age, and requires a lot of training to get good results and interpret them. if you at the GP/family doctor, and you want to eliminate symptoms quickly, the stethoscope is super quick. sure, if you are looking for fluids to drain, ultrasound is great. But you are looking for something and you need to be precise so you can shove the drain in the right place. my doctor friend says: "ultrasounds are great, but they are really hard to understand. I used to do brainscans on newborns, and I fucking hated it" (the inference being that getting a good image was tricky and fatiguing)
  • haldujai 4y ago
    I personally hate reporting NICU brains (not a pediatric radiologist), even for sonographers it’s usually just a subset who are qualified to do them. Slightly poor technique can make a huge difference in vascular assessment and if your settings are off you can make it look like there is hemorrhage. US reports are so heavily based on what the sonographers saw, and documented, so there is huge operator dependency/variability. I’m not sure how old your friend is, but as a recently trained rad I have little confidence in my own skills for neonatal brains to be honest, older rads had more time to develop their skills while we are much more exposed/comfortable with cross-sectional imaging these days and dependent on sonographers. I feel a lot better reporting a rapid MR protocol with the neonate in bundle and wrap (no anesthesia).
  • _qua 4y ago
    How do you think auscultation tells you the “type of lung infection”? Really the only thing A stethoscope is better at then x-ray and ultrasound for the lung exam is detection of wheezing. It is rare that auscultation actually changes my plan for a patient. I have seen enormous pneumothoraces in patients who had almost completely normal lung sounds. Of course easily detectable on x-ray and ultrasound.
    • KaiserPro 4y ago
• Findecanor 4y ago
  Sometimes a simple, portable tool is the best tool for the job. Sometimes ultrasound is better. Stethoscopes are not just used for listening to the heart, but also to the lungs and the intestines.
  • haldujai 4y ago
    Bowel auscultation has zero clinical utility.
    • Findecanor 4y ago
      Post bowel-op two weeks ago, my doctor used a stethoscope to hear if my bowels had started up again.
      • haldujai 4y ago
        Right, people do it but it has zero clinical utility as the history is way more significant (are you passing gas/stool). If you had an ileus (non moving bowel) for 2 weeks you would know without auscultating. If you’re passing gas or having bowel movements, the presence or absence of bowel sounds means nothing. If you’re not passing gas or having bowel movements after 2 weeks the auscultation findings are similarly meaningless as this is a very concerning presentation.
        • lukko 4y ago
          but what about tinkling bowel sounds as a sign of obstruction?? lol, agreed - is completely useless and of no clinical value
          • haldujai 4y ago
            I got called once at 4am to perform an urgent CT scan on a patient with “borborygmus” as a junior resident. At the time I was unfamiliar with this term (which means a rumbling or gurgling sound in the belly) and did not for a moment consider that a nephrologist was listening to someone’s belly in the middle of the night. Given how scary the word sounded I performed a stat CT. I googled it after the scan was completely normal. One of the most embarrassing and angering moments of my medical career so far. I swore since that day I would die fighting the crusade against those demons who auscultate bowel sounds.
• notorandit 4y ago
  No. For sure the stethoscope cannot replace sonography. There are a number of situations where a stethoscope is much better than any sonograph. Due mainly to the fact that the former is a lowtech device
• n8henrie 4y ago
  I think ultrasound already has replaced the stethoscope in the ED. ED physicians in the US basically all get pretty extensive training with POCUS. I truly love and practice the physical exam, but even in my 30s feel like some kind of dinosaur in this respect. I've written letters of profound gratitude to my ultrasound director, as probably the most impactful training in preparation for my rural practice. I have literally never had an inpatient colleague -- from rural to academics -- admit a patient for eg pneumonia without an X-ray, no matter how young and otherwise healthy or how convincingly the history and vitals match my carefully documented auscultation, egophony, and percussion. It's a waste of everyone's time to even try. As a result, many of my colleagues skip the middle man and don't bother with much exam. Some don't even bring a stethoscope to work anymore. Which makes me sad.
  • lukko 4y ago
    I think CXR in pneumonia is justified - if there's deterioration it's very helpful to have imaging at admission and consolidation on a CXR is usually expected for diagnosis (in UK), especially if the patient is requiring oxygen and sick enough for admission. I totally get what you mean though - unfortunately clinical examination is not trusted and valued. I guess POCUS is sort of just an extended clinical examination with more hardware...
  • haldujai 4y ago
    I’m SHOCKED to read a staff physician, especially as young as you are, is performing egophany and percussion. If your comments didn’t so strongly suggest that you are a very competent and diligent physician I would honestly call BS. Good for you though, I haven’t seen these exams performed done since the clinical skills course during preclerkship of medical school. It’s honestly a running joke in my medical friend group, when we used to teach the medical students we’d have to pull out a copy of Bates and remind ourselves how to do those and whispered pectoriloquy haha.
• AussieWog93 4y ago
  Why would you want to replace something that's light, fits around your neck, requires no power or setup and can complete the diagnosis in under a minute with an AI-connected ultrasound machine?
  • nadermx 4y ago
    For science
  • smileysteve 4y ago
    Consider that the veterinarian market has had ultrasound machines you carry on your neck with screens, and now have smart phone add-ons. Convenience is no longer a significant differentiator.
• ThinkBeat 4y ago
  Take something that is cheap to make, works with no need for power and that can last for decades with complicated technology. Yes, if you happen to be in a country with money and technology sure. for some cases. I hope they will still train doctors how to use a Stethoscope and drill it into them. Years ago I read that BillyG got a full MR once a year That way the billionaires' doctors could look for changes. growths, and whatever else may show up in a delta. Sounds like a good idea. If everyone had a full MRI every 6 months, a lot of issues would be resolved earlier, I think. (I am not a doctor). So a lot of doctors visits and exams could be eliminated. We would just need a sh*tload of MRI machines everywhere. On that note could you just make a conveyor belt? One person at a time, 0.5 m between each person? I mean to make the process efficient. Maybe add a few XR or CTs on the path, some blood. sprinkle AI and we will have a Silicon Valley sensation. Someone write me a check now.