slides
Ultrasound stethoscopy
- Publication date
- 27 November 2002
- Publisher
- In this thesis we repmi the many evaluation studies with the hand-held ultrasound device in
the assessment of different cardiac pathologies and in different clinical settings. The reason
for using the tetm "ultrasound stethoscopy" is that these devices are augmenting our physical
examination by allowing to visualise the heart and hence extend our physical sense of
"seeing". Since stethoscopy stands for "seeing the heart" as previously mentioned, the tenn
ultrasound stethoscope seems to be the most appropriate term describing these instruments.
One could argue that the introduction of echocardiography at the bedside could weaken the
importance of auscultation and the physical examination in particular. However, it was
echocardiography that brought out the limitations of physical examination in many cardiac conditions and also exposed human auditory limitations (7-10). Although auscultation entered
a modem era with the introduction of electronic stethoscopes (11 ), physicians rely on more
sophisticated technology. Inadequate training and time pressure due to increasing work load
of patients in combination with the availability of advanced technologies are the reasons of
poor auscultatory proficiency seen in recently trained physicians particularly in developed
countries (12). Nevertheless, we have to admit that direct observation such as seeing is more
accurate for cardiac diagnosis than indirect observation such as hearing. "Seeing" enables the
preclinical detection of pathologies and especially pathologies that are beyond physical signs,
e.g. small mass lesions.
The first reactions from experienced echocardiographers to the ultrasound stethoscope
were related to its capabilities/limitations and the training required for physicians who use it
(13). The last 2 years refinements in the technology of the ultrasound stethoscopes and
addition of modalities like spectral Doppler and M-Mode have improved the diagnostic
potentials of these devices.
No doubt that training is required to use an imaging device. Recently the American Society of
Cardiology (14) published guidelines regarding the use of ultrasound stethoscopes
recommending Level I of training (15) as an absolute minimal level required. However, recent
studies have shown that it is possible to train physicians and students for the detection of
significant pathologies in a short period ( 16,17).