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PREFACE
Ultrasound is the least mature of the major medical imaging technologies. Though the 1940s mark the first serious experiments with medical ultrasound,it was the 1970s that nurtured the first regular clinical use of the technology. Static gray scale images and the first measurements of blood flow using spectral Doppler were the innovations of the day. In the 1980s we put color on the spectra and Color Flow Doppler was born. In the 1990s ultrasound exploded with contrast agents and the beginnings of 3D ultrasound. The first decade of this century brought the dawn of 4D images,quantitative ultrasound,and elastography. Even in the last five years the advances are accelerated as ultrasound science is married to consumer electronics more powerful than supercomputers just a decade ago. And there is no end in sight. Both your untrained mother and daughter could look at two recent ultrasound images and very quickly and intuitively determine which was from the system only two years older.
No other major imaging method is changing in its fundamental characteristics as quickly.
To this remarkable technical change,medicine adds another transformation: Point of Care Ultrasound. Point of Care - often referred to as PoC - is the broadening of ultrasound from the traditional realm of the diagnostic disciplines of Radiology,Cardiology and Obstetrics to other care areas: Emergency,surgical guidance,critical care,rheumatology,endocrinology,and more. But PoC is not just the broadening of applications. The dawn of PoC Ultrasound is a completely new way to use ultrasound,a fundamental departure from the workflow of the traditional ultrasound department.
Traditional ultrasound is the land of the photojournalist. The assignment is to take a picture that is so compelling that some other caregiver will take an action: The anatomy and flow of blood through a mitral valve stenosis so that the cardiac surgeon will open the fused leaflet. According to the extent and shape of the liver tumor,the interventionalist will ablate the tumor.
But PoC is different. PoC ultrasound users do not have to convince anyone but themselves. They only need to see well enough to intervene themselves. They may insert a needle,or adjust a prescription,or stop compressing.In this sense,they see the ultrasound not as a camera,but a flashlight.The implications for instrumentation and clinical practice are enormous.
These new users are shaping the future of ultrasound. As users switch their expectations from using radiology’s extra system to demanding PoC-specific devices,tuning imaging and workflow to their specific needs,the boundaries of ultrasound are being reshaped. This revolution will be different,of course. It will bring ultrasound to more caregivers and more patients. PoC ultrasound is at the boundary between blind caregivers-dependent on feel and hearing-to sighted caregivers throughout our healthcare system.
It is a good thing. The misuse of a good thing is possible,of course,and we will need to be good stewards of this technology. What science,engineering,and medicine make possible,will have to be governed by public policy,ethics,and discovery. But in the end,it is a good thing,something for us to enthusiastically embrace and guide into the next transformation of care.
Proper understanding of the technology and its application will be essential. The inevitable expanded applications of ultrasound will be properly guided as its innovators become experts. Textbooks like this one are part of developing the expertise and intuition required to make Point of Care ultrasound safe,effective,and broadly used,to the benefits of patients,caregivers,and those that pay for their care.
Paul Mullen
General Manager,Point of Care Ultrasound
GE Healthcare
April 2018