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       Dr Gonzalo E. Díaz M  - Ultrasound - Telemedicine             




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Ultrasound, computer science and operator's skills

Ultrasound diagnosis is a highly interactive procedure. The more algorithms you use, the more things you can detect. Quality depends on operator's skills, the hardware and software we use and on the time dedicated to the examination. There is no special process or protocol when "something is difficult to see." A few years ago you must know ultrasound basis and physics and use the best algorithm you think is useful. Now, your would be better off with a good knowledge of computer science.

Tool's utility depends on operators' skills but the operator must know which tools to use. And computers (software and hardware) are new useful tools helping us with our work. Ultrasound diagnosis translates echoes to electric pulses (transducer) and electric pulses to digital representations (Digital Scan Converter) or video images (video adaptor), or directly it produces digital images. What we detect depends on the translation itself and on the operator as well. Translation is rather arbitrary and diagnosis is somehow relative. The more knowledge, tools, algorithms and time you dedicate, the better. That is why ultrasonography potentiality is so wide. We must include a good knowledge of computer science to get a good diagnosis and there must be a balance among these factors.

Computer science and technology in general let us face a huge amount of information that we have no means to keep a proper knowledge about many fields. So we need a team to get the best diagnosis. Physicians are no more the "Kings" or "Wise people" whose opinions were no subject of doubt.

Now we need the help of other specialists to get the best diagnosis and best treatment we can. We need consult bacteriologists, pathologists, radiologists, sonologists, etc. All do "medical diagnosis" in their own way, which can be accepted or rejected when collecting information to state a treatment. Diagnostic ultrasound maybe plays the most important role when talking about diagnostic aids.

We have no "ultimate diagnosis." We have just probabilities because diagnosis differs as we have proved through this discussion. Economical reasons (HMO's, insurance companies, legal limitations, etc.) have changed the friendly way physicians took care of our patients (I have always confronted it).

Ultrasound easily replaces our old stethoscope the same way computers replace our old and friendly books. Computers also replace our old clinical histories and our medical images spoiled by dust and time to be safely and digitally stored in a way that can be exchanged through the internet, have unlimited copies, etc. No need for the physicians to be physically near their patients. Telemedicine, including telesonography widen our services to any places, no matter how far they are (ask NASA). Ultrasound diagnosis has been used since 1942 when Dr. Karl Dussik tried to detect a brain tumor and we have found no side effects yet. It does not hurt and it practically lets us see inside the patient's body. And consider how far we have gone since then.

A good clinician could do a good work with no diagnosis aids, but chances are they get in trouble. Ultrasound has limitations but also has tremendous advantages that can be used to help people. We cannot replace the medical act we were used to with electronically transmitted information. But we can take advantage of technology, especially of computer science and try to do our best. We can do good Ultrasound diagnosis out of electronically transmitted information and better yet, we can improve our diagnosis with the help of computers. We can improve images, we can acquire new information, etc.

Paramedics are not physicians but they save many lives by electronically transmitted information about their patients, so the specialists diagnose and recommend a treatment to save the patient's life without even being in touch with them.

Solutions depend not only on problems but on circumstances as well. We can do our best when facing a problem in a given environment but this does not disregard better solutions in easier situations. Ultrasound is probably the most efficient diagnostic tool we have now and deserves our respect and effort. Ultrasound potentiality is unlimited.

The facts

Technology cannot replace the old, friendly, useful and reliable medical act. However, day by day it is much more difficult to gain access to that kind of medical act. Each time, fewer physicians are willing to do it because the way the system behaves. While we can demand physicians behave the old and friendly way, few of us would be willing to pay its monetary cost. We cannot replace human care with technology, but we do can improve our lives with technology.