New York—November 28, 2008
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.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics and No. 4 in rheumatology by U.S. News & World Report (2008), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery 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.