In Guyana multiple false beliefs have been developed and repeated about ultrasound. These myths are harmful and can reduce quality of patient care and result in increased morbidity and mortality. Here we'll debunk these myths.
MYTH #1. "Ultrasound is fast! The fastest!"
This myth was obviously invented to make more money with ultrasound. Let's explore why it can't be true. An x-ray is completed in less than 1 second per shot. A CT scan of the entire body on a 64 slice CT would be completed during a single breath hold-less than 1 minute. Ultrasound makes images in paper-thin slices 7 cm wide. To complete a scan of the abdomen each organ must be completely examined one slice at a time, with images of each part recorded in anatomic orientation, labeled accordingly and stored. Each of these steps must be manually completed by the sonographer. Ultrasound is the most sensitive modality to different body types and factors such as bladder fullness, or last meal and manual adjustments and patient positioning must be done along the way. So, it is not unreasonable that actually, the average time for a diagnostic abdominal ultrasound is 30 minutes according to the Mayo clinic.
But where did this myth come from. Yes, people use it to make more money, but is there any truth at all that it might be based on? Yes, there is some truth to it. Point-of-care ultrasound, also known as POCUS, is used by physicians while treating patients for example in a ward or emergency room to answer a specific question in order to make a management decision, e.g., is the bladder full or not, is the baby's head down or not, etcetera. It is not a full diagnostic exam. This can be extremely fast, as ultrasound equipment can be small and portable and doesn't need radiation protection to operate. This is the only situation where ultrasound is fast. Ultrasound is slow.
MYTH #2 "Ultrasound interpretation is user dependent."
Ultrasound interpretation is not more user dependent than any other modality. A stone, for example, has known characteristics that cannot be mistaken on ultrasound. A person that calls any bright spot a stone without it having the features of a stone is not excused by any user dependent nature of ultrasound. They simply are not adequately trained. This myth is also used as an excuse not to store images as it is believed that two persons should normally look at the same ultrasound image and have different interpretations. This is simply not true. Ultrasound is learned by textbooks with pictures. Radiologists must sit exams where they have to interpret ultrasound images on a screen or printed on paper. Sonographers sit exams where they have to produce high quality images of known pathology.
This myth came about because of unregulated practice of ultrasound in Guyana and serves to absolve persons who would make incorrect diagnoses because lack of training. However, it is a corruption of a truth: Ultrasound is user dependent in that the time it takes each user to acquire good quality images for interpretation can vary widely even among seasoned sonographers. This is due to the very manual nature of ultrasound image capturing and small field of view as described in the previous section. The Ministry of Health of Guyana has made great strides in strengthening the regulations for accountability in ultrasound practice.
MYTH #3 "Ultrasound is easy."
Ultrasound is not easier than any other imaging test. Sonographers must do up to four years of training like any other technologist. Residents must complete several blocks of ultrasound before they can become a radiologist. It takes training and practice to master like any other part of radiology. Point of care ultrasound POCUS training is not a substitute for sonographer or radiologist training. POCUS is extremely helpful and can be lifesaving but taken beyond scope of training can be dangerous.
MYTH #4 "Ultrasound is hard."
The opposite myth to ultrasound is so easy anybody can do it is that ultrasound is so hard only the divine can adequately perform and interpret it. This also is used as an excuse not to record any images because only that radiologist or sonographer with their godlike powers could understand what was seen anyway. There is no explanation needed to debunk this. It just needs to be said out loud and you will know how ridiculous it is.
Some patients can be extremely difficult and experienced sonographers can seem to have an easier time getting images, however, the interpretation would be the same.
MYTH #5 "The sonographer knows what they're looking at. They can just tell me."
The sonographer does know what they are looking at, but they cannot just tell you. Ultrasound interpretation is more nuanced that just shades of grey and measurements. Take for instance ovary size. Enlarged ovaries can be a sign of polycystic ovarian syndrome, fertility treatments or torsion, to name a few. It depends on the patient's age, the symptoms with which the patient presents, any clinical findings the doctor would have included in the request, blood tests and previous imaging, any medications they might be taking, etcetera. These are not things the sonographer is trained to interpret. The sonographer is not a doctor. Through experience, the sonographer will start to learn some of these things and will practically be able to make certain diagnoses with confidence, however, ethically and legally, the responsibility to pronounce a patient with a disease or not and to recommend further care is that of the appropriately qualified medical practitioner-the radiologist.
MYTH #6 "My doctor just needs the report. I don't need images."
Your doctor will ask you to repeat the ultrasound if they don't agree with what the report says or simply because you did the ultrasound at the wrong place. That is at best annoying, and at worse, could kill you if you had an urgent complication and needed surgery and had to repeat a whole ultrasound first. This problem occurs every day and would be almost completely eliminated by country-wide adoption of the standards for storage and transmission of images of all anatomy described on a report. Incomplete examinations would be the only purpose for a repeat scan.
MYTH #7 "Guyana is too poor to do ultrasound according to standards."
This is usually the last-ditch argument. Guyana is too poor not to follow standards. When people spend money to get an ultrasound and it's accurate or it might be accurate but is repeated because the system is built on uncertainty, people lose money that they could be using to help themselves and family. Poor diagnosis leads to poor treatment, loss of health and income and economic decline. All-all ultrasound machines in use in Guyana today can store and transmit image and patient data. Most hospitals already have a system to store patient imaging tests. They simply choose not to include ultrasound. There would be minimal extra cost attached to storing it and having it available for your doctor to see. The only consequence to care providers is that each test would take more time and so they would see less "customers."
Add comment
Comments