Dan Chambers RDCS, RVT, Cardiovascular Program Director, Providence Health Columbia SC
My first experience in sonography began in August of 1977. At that time, I was serving in the United States Air Force as a radiology technologist and was ‘volunteered’ to learn the new technology. Making use of a single crystal probe and developing scan technique, we were able to produce diagnostic images of the kidneys, liver, gall bladder and related structures. This B mode imaging, no matter its limitations, was nothing short of amazing.
Since that time, the field has continued to evolve and make tremendous advances in real time imaging, harmonics, blood flow velocities in color and Spectral Doppler, as well as Doppler Tissue Imaging. Engineers are still hard at work, squeezing every bit of diagnostic information possible out of this sound wave.
“An ultrasound system, with imaging and Color Doppler that was once as large as a refrigerator is now able to fit in a shirt pocket”
I was fortunate to have gone on to specialize in cardiovascular sonography, with experiences in a wide range of environments. Staff and supervisory positions, working as a clinical representative for the industry leader in cardiac sonography and, for a while, as a traveler. It has been my honor for the past 13 years to be an educator in a formal program, training the next generation of cardiovascular sonographers. Part of this education is to understand where we came from, where we are, and to look to the future to see where our skills may fit the best. Medicine is challenged with becoming faster, better, stronger, and our field is no different.
Worldwide, cardiovascular diseases are the number one cause of death and affect the health of over 90 million Americans. Recent advancements demonstrate the importance of cardiac sonography with advantages in speed of real time imaging, cost effectiveness and significant diagnostic value.
Echocardiography is among the most used of the imaging modalities for evaluating cardiac structure and function. While harmonics, multi-frequency and automated optimization controls have improved imaging capabilities, an estimated 20 percent of these studies may be suboptimal with poor diagnostic value. A tremendous leap forward was seen with the introduction of ‘imaging agents,’ micro bubbles small enough (<8 μm) to pass through the capillaries in the lungs to reach the left heart. These products aid in the enhancement of the blood-pool tissue interface, enabling diagnostic results even in difficult circumstances. The safety and efficacy have been well documented and should be a vital part of the success of every echo department.
Quantitative volumetric assessment of the Left Ventricle, including calculation of LV EF with 3D echocardiography is currently recommended over 2D echocardiography when feasible. Three-dimensional echocardiography overcomes limitations of 2D tomographic imaging such as, LV foreshortening and geometric assumptions regarding LV shape. Advances in probe technology and software have given real time 3Dgreater diagnostic value. The growth of the structural heart programs at most major medical centers, with advances in TAVR, Mitra Clip, and Watchman procedures, would not be possible without 3D trans-esophageal echocardiography, and the expertise of the Cardiologists and Sonographers.
And today, the stethoscope, long recognized as an essential part in the early diagnosis of the cardiac patient, may have seen its best day. Smaller devices are now more affordable and portable than ever. The emergence of Point-of-care ultrasound (POCUS) has become, for many physicians, an integral tool for patient management decisions. An ultrasound system, with imaging and Color Doppler that was once as large as a refrigerator is now able to fit in a shirt pocket. Beautiful, high frequency images, viewed on a tablet or smart phone, and operated by an application. And even just this week, a medical technology company was awarded a patent for their AI software to assist in the training of those tasked with performing this type of patient care. In my dreams, I could never have imagined it would have advanced so far, so fast.
For over forty years I have been amazed at the many tremendous improvements and advancements in our field. My career is winding down, but those entering the field today will have opportunities with technological advancements that will be every bit as astounding as the past four decades. Cardiovascular sonography remains a significant factor in the early treatment of cardiovascular disease.