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Ultrasound without standing in line to the clinic or hospital? It is possible because today an ultrasound scanner in a doctor’s pocket can come to our home. About new possibilities of imaging diagnostics and about when such examination saves lives – says prof. Wiesław Jakubowski from the Medical University of Warsaw.
Halina Pilonis, MedTvoiLokony: What does ultrasound have to do with a bat?
prof. Wiesław Jakubowski: Like this mammal, it uses waves to visualize the surrounding space. The bat sends out waves and records how it bounces off any obstacle it encounters. Similarly, an ultrasound scanner creates an image on the screen as a result of the reflection of ultrasound emitted by the device, i.e. sounds with a frequency inaudible to humans.
How does this examination relate to X-rays, computed tomography or magnetic resonance imaging?
It is the only imaging test that is completely safe. The others require some precautions. The best proof of this is that ultrasound can and must be done during pregnancy. This does not mean, however, that ultrasound is able to replace other imaging tests. With its use, we will not diagnose, for example, spine diseases, changes in the brain. It will also not show us the structure of the bone like an X-ray or magnetic resonance imaging, but it will show the periosteum, i.e. the top layer of bone. However, there is no organ or tissue in our body that cannot be examined with an ultrasound.
What are the advantages of this test, apart from being absolutely safe?
Diagnostics should be as soon as possible. Ultrasound examination enables its quick completion by excluding disturbing changes or directs further research. For example, if a woman feels a lump in her breast, an ultrasound scan may quickly reassure her that it is a benign cyst or may be an indication for a biopsy of the lesion. Thanks to ultrasound, the family doctor, for example, when he suspects a rib fracture, does not have to send the patient to the X-ray laboratory for an X-ray, but he can put the head on and check if everything is okay.
Is ultrasound also quite safe for the fetus and babies?
Yes. Tests performed during pregnancy make it possible to detect defects in the case of which the early treatment saves the child’s life. Babies sometimes cry during the examination, but it is certainly not because it is harming them. In order to avoid unpleasant sensations, when examining newborns, for whom the cold gel used in ultrasound could cause crying, it is heated in special heaters.
What are the limitations for such diagnostics?
They mainly result from the principles of wave emission. Unfortunately, they reflect off the air. Therefore, a large amount of gases in the digestive tract of the subject may make diagnosis difficult. However, you can change the position during the test or the place where the probe is applied. The cooperation of the patient is also important, as the doctor may, for example, ask for the air to remain in the lungs for a while. Sometimes it is also difficult to examine patients with pain or wounds after operations.
Where do diagnostic mistakes come from in ultrasound examinations?
Most often because of the ignorance of the examiner. Sometimes due to the defectiveness of the equipment on which it is made.
So how do we know if the doctor we are going to has the appropriate qualifications and the equipment he works on is of good quality?
Unfortunately, there are no regulations in Poland that would say who can perform ultrasound examinations. Such regulations are in most EU countries. This is a neglect of our health ministry. The Polish Ultrasound Society certifies doctors that they have knowledge and skills in this field. They are issued for five years. After this time, they must be renewed. The Society also grants accreditation to ultrasound laboratories that meet the technical requirements necessary for proper diagnostics and are a guarantee of the quality of the equipment they work on. It is worth checking whether the facility we use has such certificates.
Do Poles use ultrasound diagnostics?
Last year, according to the data of the Polish Ultrasound Society, 16 million examinations were performed. That’s a lot. But if we take into account that every woman should have a breast ultrasound once a year, and everyone with a family history of pancreatic, thyroid or kidney cancer should also have a preventive examination, then this number is not that big.
When is it worth having a prophylactic ultrasound?
As often as possible. Relatives, instead of buying unnecessary toys for the child on various occasions, could offer him a prophylactic ultrasound examination once a year. In partnerships, the proof of mutual concern for each other would certainly be buying yourself such research. And if a woman notices that her partner is urinating longer and longer and, in addition, gets up at night for this purpose, she should persuade him to undergo a prostate ultrasound. Gentlemen, on the other hand, could remind their partners about breast and gynecological ultrasound. Also, people with family cancerous burdens should do such tests.
Why is it not done ultrasound as preventive examinations for everything, such as mammography?
The condition of such screening tests is their identical repeatability, i.e. they should be done the same each time. Meanwhile, in the case of ultrasound, a lot depends on where the doctor puts the transducer. However, I think it is a matter of two or three years when such heads will appear, which will be stationary, put on exactly the same place, giving a comparable image each time. In addition, in the case of mammography, 10 percent. due to the glandular structure of the breast tissue, neoplasm may be overlooked. Therefore, these two studies should complement each other.
Will portable “pocket” ultrasound improve diagnosis of diseases?
The breakthrough was a device the size of a chair on wheels, which can be transported to a sick bed in a hospital. Meanwhile, the head that can be hidden in a pocket and a screen the size of a laptop make it possible to reach the bedridden patient at his home or examine him at the scene of an accident or disaster. And at the patient’s request, an ultrasound may be performed during a home medical visit, e.g. of a pregnant woman. For now, this device is expensive, but in the future such an ultrasound scanner will certainly be like a stethoscope, always within the reach of a doctor.
Or maybe in the future it will become an application for a mobile phone and when the patient applies it to different places, the diagnosis will appear on the screen?
I don’t think so, because medicine is an art and in her case two plus two doesn’t always make four. Attempted to use artificial intelligence to operate the ultrasound, but it did not work. The doctor’s knowledge, experience and intuition are needed. The diagnosis is the sum of many data, and the so-called An “average” patient does not exist. However, ultrasound is used for self-monitoring of patients with a ruptured spine, who can use this device to check the residual urine in the bladder and empty it if necessary.
Can an ultrasound save a life?
Surely. First of all, in emergency medicine, when we are dealing with the so-called The “golden hour”. If the patient does not receive proper help during this time, he will die. Meanwhile, the ultrasound will tell us in just two minutes whether the victim has blood in the abdomen, pericardium or lungs. This is a life-threatening situation, and this information determines what to do next. In tests at an outpatient clinic, ultrasound allows to detect many types of neoplasms that, if diagnosed at an early stage, can be cured. It also gives a chance to illustrate other deadly diseases. It happened to me that in patients complaining of pain in the groin area, I diagnosed a life-threatening ectopic pregnancy, and in patients suffering from liver colic, a deadly five-centimeter abdominal aortic aneurysm.
Recently, 3D and 4D ultrasound examinations have appeared in the offer of many health care facilities. Is it worth doing them?
The 2D system shows the image in one plane, while thanks to 3D and 4D imaging we can observe the organ or the fetus in different planes and at different angles. It is a very good method to detect, for example, cleft palate, spina bifida or a heart defect in a fetus. Thanks to 3D and 4D ultrasound during pregnancy, it is also possible to measure the volume of parenchymal organs of the fetus: kidneys, spleen, liver, brain, lungs. The advantage of 3D over 2D is especially visible in defects of surface structures, craniofacial, limbs and neural tube. 3D imaging is static, while 4D imaging is spatial real-time imaging. Thanks to this, you can see the appearance of the child’s face, precisely assess the structure of the heart or limbs. 3D ultrasound examination is useful not only during pregnancy. In gynecological ultrasound, it is used to diagnose congenital uterine defects. It shows the shape of the uterine cavity better than two-dimensional ultrasound. In ovarian lesions, it helps to assess the degree of vascularization, the density of the blood vessel network in a tumor or cyst.
prof. dr hab. n. med. Wiesław Jakubowski – graduate of the Medical University of Warsaw, specialist in nuclear medicine. Head of the Imaging Diagnostics Department of the 282nd Faculty of Medicine at the Medical University of Warsaw, member and founder of the Polish Ultrasound Society and its chairman for four four-year terms, founder of the ULTRASONOGRAFIA quarterly of the scientific body of the Polish Ultrasound Society. Founder of the Roztocze School of Ultrasound in Zamość. A specialist in the field of diagnostic applications of ultrasound. One of the founders of teaching professional ultrasound in Poland. Author and co-author of 24 scientific papers, 286 book monographs, 17 presentations at national and international conventions, tutor of 48 nuclear medicine specializations, 8 completed doctoral dissertations and the tutor of XNUMX habilitation programs.