For over seventy years, ultrasound imaging has been used by medical professionals to evaluate, diagnose, and treat a variety of conditions. The use of the modality is wide-ranging and can be found in radiology departments, OB/GYN practices, emergency medicine, and more. Since the founding of the American Institute of Ultrasound in Medicine (AIUM) in 1952, ultrasound use has continued to grow at a steady pace and much of its popularity can be accredited to its reputation of safety.
Ultrasound is the primary imaging technology used in a variety of specialties which comprise diagnostic medical sonography. Correspondingly, this includes clinical areas such as abdominal, breast, cardiac, obstetrics, gynecology, pediatrics, and phlebology. In addition to its diagnostic uses, ultrasound is increasingly becoming one of the modalities of choice in interventional settings. This encompasses a wide range of clinical areas and specialties, such as radiology, pain management, anesthesia, and urology. The versatility of ultrasound has caused it to become a more popular choice for certain applications, such as biopsies. As a result, ultrasound-guided biopsies have become more common, particularly prostate and breast biopsies. By permitting the operator to see the target area with greater clarity, the risk of hitting unwanted vessels is reduced and thus improves patient comfort and safety.
In addition to its ease of use, ultrasound offers other benefits to clinicians. Unlike some common imaging modalities, such as computed tomography (CT) scans, ultrasound does not expose patients to radiation. It can also be performed on patients who have pacemakers or other metal implants, in contrast to magnetic resonance imaging (MRI). The design of the ultrasound transducer means that it can be easily used outside of the imaging suite; thereby, eliminating the need to move patients. Point-of-care ultrasound (POCUS) provides a convenient way for practitioners to diagnose and evaluate patients, especially in emergency cases which involve critically ill or injured patients. By providing clinicians with real-time information, POCUS has played a significant role in accelerating the speed of diagnosis and treatment of certain cases. Its rise is augmented by new technologies that allow practitioners to use a tablet or phone to perform the scan. The American Society of Radiologic Technologists (ASRT) notes how the increased use of POCUS is also tied to the modality’s aforementioned lack of radiation exposure and has been bolstered by radiation protection concerns on the part of clinicians (Buerger and Clark, 2017).
As mentioned prior, the use of ultrasound outside of diagnostic medical sonography has expanded in recent years. A 2018 survey conducted by the University of Louisville found that ultrasound use was especially high in multiple settings outside of diagnostic medical sonography. The survey included responses from over 300 U.S. infection preventionists. When asked of ultrasound usage in their departments, the following had the highest rates: radiology, OB/GYN, emergency, cardiology, operating room, and ICU. More than 80% of each of the respondents for these departments indicated that ultrasound was being used. The ASRT notes how the expansion of use to other specialties signifies the use of the equipment by “nonimaging healthcare professionals,” and points out how adequate training will need to be provided to these individuals to ensure success.
Although the growth of ultrasound has brought clinical benefits, it has not come without its risks. The research team from the University of Louisville warned that this rapid expansion in use may pose a hazard to patient safety in the form of “preventable infection risk” (Carrico et al, 2018). To maximize infection prevention, medical staff are expected to clean and disinfect transducers used for the scan or procedure along with ensuring that any additional supplies, such as gels and covers, are also adapted to the nature of the scan. In 2016, The Joint Commission found that 74% of all immediate threats to life declarations were associated with improper sterilization or high-level disinfected equipment. The researchers from Louisville wrote, “These outbreaks demonstrate the risks associated with surface ultrasound-guided procedures and suggest the probe and gel can contaminate the puncture site during imaging” (Carrico et al, 2018). Therefore, the use of appropriate ultrasound supplies, particularly in environments where the sterile field must be preserved, is crucial to patient safety. It must be understood that, although ultrasound may be considered a generally safe imaging modality, it can still be a vector of healthcare-associated infections. Previously conducted studies have proven that contaminated probes, especially in interventional settings, can pose a significant danger to patients.
