Augusta, GA (WJBF) – We are looking at the future of medical – the latest, greatest technology that is allowing doctors to see what is happening inside your body anytime, anywhere. It is portable ultrasound – ultra portable ultrasound, and experts from the Medical College of Georgia at Augusta University explain how it works and then will show you with a demonstration on the show.
– Let’s begin by talking about this medical technology, this ultra portable ultrasound. And to do that, we have Dr. Matthew Lyon, the executive director of the MCG Center for Ultrasound Education. Next to Dr. Lyon is Becky Johnson-Etheridge, the director of the MCG Ultrasound Education program over there. Than you all both for being here. I appreciate it.
– Thank you, thank you.
– Thanks for having us.
– Let’s talk, first of all, Dr. Lyon, about the device itself which if you all can see it, I have an iPad here, you basically have the same thing. It threw me that that’s the device. It’s tiny compared to say what was used to see our sons when they were in my wife’s tummy. And I imagine there’s a cost difference between traditional ultrasound and this.
– Sure, I mean the explosion of smartphone technology has led to advances in all kinds of medical technology. And particularly, for us, it’s been ultrasound technology. And so it’s become a lighter, smaller, faster, and less costly. And so it’s getting to the point where every clinician can use ultrasound to help their patients and not just using specialists like radiologists.
– Does this replace the old technology, Becky? Can we just start using these exclusively going forward?
– No, it does not. It really is just an adjunct to what the physician is examining their patient. They’re looking for specific things with this. We teach our medical students, and residents, and fellows at MCG to do this. And we are not teaching them to be sonographers or radiologists, or to do a diagnostic study. We are teaching them, at the bedside, to use ultrasound to find out a very specific question that they need to know right then to help the patient.
– What all can that thing see inside your body?
– Well, it depends on what kind of transducer you use, but it does everything that any other ultrasound would do. So we can look at the heart, the abdomen, we can look for babies, all of those things. But as Becky said, what we’re trying to do is make clinicians better by allowing them to use a technology that aids them in making sure somebody doesn’t have an emergent diagnosis and help them get what the best test is to find out what’s wrong with their patient.
– Well, so going along those lines, can this be something that expedites the triage process?
– Triage as well as the testing process. So a lot of times, your history and physical exam gives you a lot of differential diagnosis, what could be wrong with the patient. You have to work through those with diagnostic tests. This helps you by either ruling out some of those potential diagnoses or helping you figure out which one’s the most likely, and then you order the best test to tell you for sure.
– Tell me, and you may not be able to answer this, it may be too early in the game, but typically, would you go from a scan or a pre-diagnosis with this unit and then go on to more traditional ultrasound means? Or sometimes, can this be the only thing needed?
– Well, it depends on what the problem is. But like he’s saying, it is a screening tool at the patient’s bedside. So if something was discovered, they could go on for further testing with a diagnostic ultrasound to radiology or cardiology or whatever the case may be.
– And typically, and I hate to just keep harping on the cost thing, but a lot of our viewers, whenever we cover anything medical, they’re always concerned about the cost, will insurance cover it. If you were able to just use this, if it was something on the simpler end of the spectrum, could it reduce your final bill?
– Yes, definitely, because like I said, a lot of the cost in medical care is the testing that is needed. And so if you’re not using as much testing, then the cost is less.
– Can you talk to me about the pre-hospital applications for this?
– Sure. We have air medical service, and it’s used extensively across the country. And as these machines become smaller and lighter, they’re starting to show up in ambulances. So it’s an emerging technology. When I started with using ultrasound in my clinical in residency, which is about 15 years ago, the machines were very large, very expensive. And over that 15 years, the technology has increased. We’re down to the size where every clinician can have it cost wise, size wise, portability wise, fit in your pocket. And so just think about where we’re gonna be in another 15 years.
– [Brad] It’s amazing just how far it’s come, as you’ve said, in that short time. Can it decrease the time that a patient has to be under your care because you can do that pre diagnosis, if you will?
– [Becky] Yes.
– [Brad] Tell me about that.
– [Becky] Well, if the patient, if there are no findings, you could move on to something else. So that’s what we see at the bedside, is that it tells you a yes-no answer to a question that could lead you to say, “Well, we’ve ruled that out now. “Let’s move on to the next set of diagnoses.”
– [Matthew] I’ll give you an example.
– [Brad] Sure.
– So I’m an emergency physician. That’s where a lot of the clinician use of ultrasound began. And so if you have a patient that’s in cardiac arrest, and they show up and you have to take care of them, ultrasound can quickly tell you if their heart’s beating or not, if you need to treat that. If it’s another cause of why they don’t have a blood pressure or they’re critically ill, it quickly finds those things that you can quickly make an impact on to help them immediately.
– What about the accuracy and the confidence that something like this gives you? Tell me what level you feel with that.
– So this doesn’t replace everything that the clinician already knows. So they’re already using their history and their physical exam to create a picture of what’s going on with the patient. This is an adjunct to make that more accurate. So you can’t look at this and it’s just as a tool by itself. It’s an add-on to everything else we’re doing. And so when you add it on to everything else and the more you integrate it into that history and physical exam process, the more accuracy it has.
– [Brad] The radiologists like it?
– Well, it’s an interesting thing. It’s a technology that’s traditionally been used by OB/GYN, cardiology, and radiology for very specific purposes. And clinicians, when they started using this technology, used it in different means, different ways. And again, the clinician uses it to help figure out what’s going on with the patient right there at their bedside. So it’s a little bit different use, but we’ve been very supported by radiology.
– They generally like it.
– What about the amount of training that goes in before you can be cut loose with one of these?
– That’s a big question, is how much training you have to have before you’re competent with any technology. And so that’s one of the missions of us at the Center for Ultrasound Education is, is we’re integrating it throughout medical school and then into the residencies and fellowships so that people have that longitudinal experience to get better with using the technology to help patients and how they integrate that in their patient care.
– So is it a semester? Is it a weekend?
– Well, as far as the medical students, we have it in all four years of medical school now. And we start off, we use the ultrasound as an educational tool. They’ve learned what they have to learn. We’ve focused on anatomy or physical diagnosis. And then when they get in their third and fourth years, they’re actually going out into clinic using it on patients.
– Can you put a tube or a line in somebody by using this?
– Yes, you can.
– And if so, can you tell me how that works? Same as the traditional ultrasound?
– Same as a traditional ultrasound. Again, this technology is moving down to the clinician. So unless you’re a specific kind of radiologist, you wouldn’t be doing that. But as clinicians, we do lines and tubes all the time, and this makes it much more safe. You think about if you can see where your needle’s going, you’re not going to hit something you don’t wanna do, hit. And so it’s much safer for you to be able to see where things are going. So it’s been an initiative we’ve had at Augusta University for the last several years to improve our safety when we’re doing those procedures by teaching people how to use this technology.
– Do you see an application, we touched on pre-hospital uses, the helicopter you mentioned, where a high school player could be injured and you just come up and right there on the scene, and you start the treatment or the diagnosis process. That happens, right?
– Absolutely. So a lot of our sports are unfortunately related to injuries. And so if you can make that diagnosis on the field, you can help the patient right then, the sports player right then. But more importantly, as we start getting more and more uses and we’re able to make diagnosis, let’s say a concussion, we can prevent secondary injuries because the players don’t always want to come off the field, right?
– [Brad] Right.
– And so they wanna keep playing. And so if you can show that there’s an injury, you can get them out of harm’s way and take them back to the sideline.
– Well, I just think it is incredible technology. I keep looking down at it. It’s so small. But when used big picture with the other resources you have, I think it’s fascinating. When we come back, we’re gonna take a look at exactly how this unit works. We’re going to apply that portable ultrasound technology on our “patient” who has been kind enough to show up. An MCG medical student in the building as well so we can show you what happens down at MCG at AU everyday as they practice this technology, they implement it.
– Welcome back to The Means Report, everybody. Learning about ultra portable ultrasound today. And the best way, we think, to do it is to talk about it as we did during segment one. And now to demonstrate it here in our second segment, Dr. Lyon and Becky are here to show us how to do that along with the most important member of our team right now, Valynn Antoine. Valynn is a fourth year medical student, and you’ve been studying this pretty much your whole time in med school, right?
– Correct, correct. So for the first two years, it was more so for just learning anatomy and making sure we knew how to understand the probes and understand the processes. But now, in my third and fourth year, I’m actually using it on patients in the emergency department.
– And I’m so sorry that I ignored Amy, our patient. She’s gonna help us out today, Amy, also an MCG medical student, and thanks for your help today. Let me ask you this, first of all, Dr. Lyon and Becky and I were reminiscing about the old days when the equipment was big and bulky and expensive. Is this just pretty much for a younger person, if you will, the way things should be? Or does this fascinate you at all?
– It really fascinates me how small it is. And I was just looking at the image. It’s really clear. And I think it’s pretty cool in my opinion.
– Well, why don’t I let you get to work. Tell the viewers what they’re gonna look at. This is an Android device, so this is compatible with all Android devices, this ultra portable ultrasound unit. Even a phone, Dr. Lyon?
– Even a phone.
– So you can just plug it in out there in the field or the hospital and check things out. All right, so I’ll let you get to work, and you just sort of tell the viewers what you’re doing and what we’re seeing.
– Okay, sounds good. All right.
– [Brad] What part of her body are you checking out?
– She’s looking at actually the heart on the screen here. We’re looking at it from it’s called the subcostal area, looking through the liver to see the heart. You can see the valves and the motion of the heart.
– [Brad] Yeah, keep it right there, Valynn, if you will. And Becky, excuse me for interrupting you. Marlena is gonna get a good shot of that monitor so we can see Amy’s heart beating. We hope that it’s beating. Oh, my goodness gracious.
– [Matthew] Yeah, you can see her liver at the top of the screen and down below. And below, you see her heart beating.
– [Brad] Point to the liver if you will.
– [Matthew] The liver is right here at the top, right here at the top. And then down below that, you can see her right ventricle and her left ventricle. And everything’s working perfectly on our healthy, normal model.
– Tell you what, Amy, you’re the first med student who’s been comfortable letting somebody look at their liver much less on television. Kidding, joking. It looks good, it looks good. And what about the clarity of this versus the kind of machines, doctor, that we were talking about? Just as good?
– Well, not as good as a machine that costs 10 times as much, but it is very good for doing what we’re doing at the patient’s bedside, finding out things that, again, would affect the treatment right here and right now. So it’s good enough for that.
– And we talked about confidence and accuracy, Valynn, with Dr. Lyon a moment ago and with Becky. How confident are you in what you see? And how confident are you in your ability to at least start to make a diagnosis based on this?
– Absolutely. So over time, we get more comfortable, of course, with practice. Like they said, it is a process of learning exactly how to navigate the probe and understanding what you’re looking at. But my few months at least with ED has been awesome. I feel I’m getting a little better at it.
– What other parts of the body can you look at? I don’t wanna put gel on her head, but could you look at her brain if you wanted to?
– Sure, you can look at her brain through her eye. It’s very common. We can look through the brain and see the sheath that holds the nerve behind the eye. It dilates with intercranial pressure, so you can look to see if somebody’s having a head injury. You can look at their abdomen. You can look for the liver, the spleen, the kidneys, if they have kidney stones.
– That’s the one where the dilation if you hold your nose and keep your mouth closed and blow, that’s a good way if someone’s been hurt.
– Well, it’s an experimental technique, but it is a way that we can help know that somebody has had a head injury.
– Can you hold it up to her eye and see what happens?
– Okay, yeah, all right. Marlena, take camera eight again if you will and show the shot. I just wanna see. And Amy, don’t let us make you uncomfortable. Don’t let us make you more uncomfortable. All right, so we’re gonna attempt to look into Amy’s soul. Isn’t that what the eye is the window to?
– [Valynn] It is.
– [Matthew] All right.
– [Brad] Yeah, what are we seeing, Dr. Lyon?
– [Matthew] So typically, we use a little bit different transducer for this exam. But what we’re seeing is this black area up here is her eyeball itself. And Becky can tilt back and forth, and what we can see is the structures behind the eye. And one of those structures is the optic nerve itself. And the optic nerve has a fluid around it and the same fluid that’s around the brain.
– [Brad] Which is good.
– [Matthew] Which is great. This is the nerve coming through the back. That’s one way though, we can look at the size of that sheath, ad it dilates as pressure goes up. And so we can use that to let us know that somebody has had a head injury and they have elevated intercranial pressure.
– Okay, go back real quickly to the insertion of the lines or the tubes with the patient.
– How do you all practice that? There aren’t Amys lying around on every table at MCG. How do you all do it?
– We use something called an ultrasound phantom which is essentially a block of gel that has artificial veins in it, and we practice putting needles in that. So it’s kind of like a skill that you have to learn. And you don’t wanna learn it on a patient, so you use an inanimate object to help you.
– That is absolutely fascinating. How much is that?
– Well, the price varies based on the company, but a good rule of thumb would be about 5% to 10% of a normal standalone ultrasound machine.
– That’s tremendous savings. And I will use my microphone for this. I don’t wanna end this segment without you getting to talk. Are you all right?
– I’m good.
– And your brain and your heart appear normal. That’s gotta be reassuring.
– That’s good to know. Yeah, that’s good.
– What year are you in school?
– Oh, I’m not a med student.
– Okay, I told the viewers you were a med student. I take back the first part of this segment, if you could just delete that part.
– I’m more of an animal person so I’m going for–
– She’s a standardized patient.
– Yeah, I’m a standardized patient for MCG.
– I gotcha. So you do this a lot.
– Yes, I do.
– Well, we appreciate you volunteering for us today, Amy. Amy was a good sport for sure, and she helped us learn a lot, and all of you. Valynn, best of luck with the rest of med school for you. And thank you all, Dr. Lyon, Becky, for being here. I’ve learned a ton. Any idea where you’re going to go next?
– Well, I’m hoping to stay here. We’ll see what happens.
– That will be determined on match day, right?
– Yes, it will.
– Okay, we’ll keep our fingers crossed for that, and thanks again to everybody. Wow, how technology has changed in such a short time.