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Mobile pocket echo device: Revolutionizing medicine
Posted Feb 05, 2010
at 12:40 PM, EDT
by Eric Topol
The Scripps tests of the brand-new GE VScan device show favorable comparisons with a routine full echocardiogram. It's the size of a cell phone, portable, and with inherent wireless potential and has wide-ranging—revolutionary—possibilities that stretch beyond CV care. What are your thoughts?
Disclosure: I have no financial relationship with GE. Scripps is taking part in an objective, prospective study of the GE VScan.
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Who's talking
|
Eric J Topol MD
Director, Scripps Translational Science Institute The Gary and Mary West Chair of Innovative Medicine Chief Academic Officer, Scripps Health La Jolla, CA |
Comments
Wow Eric. That's super cool!
Pocket echo is something I've often dreamed of as part of every single routine office visit Just like a BP, heart rate, 02 sat, weight , now there's an opportunity for a fresh look at LV function/MR/AI--------no more suprises! I thought it would come first as the same size as a portable echo (about 15cm screen), it's much smaller than I thought.
Congratulations! Good luck with getting that reimbursed though!!!
Melissa
Melissa,
No interest in reimbursement!!! This can get rid of countless of unnecessary echoes and make physicans so much sharper at the bedside or inthe clinic during real time visits. And get ready for patients sending their echo to you on your smartphone!
A real revolution in medical practise
hoping its readily available soon
A great tool,however what about the obese patient whose thick chest wall limits
accurate cardiac evaluation by echo
great innovation;
now training gets even more important as ever to interprete the images and to describe what is actually really NORMAL because the impact of a false negative echo done with this cellphone-quality and limitations can have huge implications
The WSJ has an article about the Vscan and pocket echo devices. In answer to questions about when this will be available, it appears that sales will start next week:
http://bit.ly/cuur9C
Great device!!
Unfortunately in Latin-America this kind of articles are very expensive...
Hi! I am Veronica Botet, from GE Healthcare. You can find all the latest information about Vscan here http://newsroom.gehealthcare.com/press-kits/vscan/
Hope you find it interesting!
Just a quick comment about the reimbursement issue. I'm sorry it took me so long to get back on this. I absolutely do not want my comments to misinterpreted in anyway as a negative. This is a fabulous advance in technology and something I've hoped for for so many years. I've always thought an echo should be performed as easily as an ECG, especially if there is any change in condition that would warrant it. How often have we wished we could "get another echo" on a patient whose legs are larger or having more shortness of breath. I've done a million of them "on the sly" when we knew there would be no reimbursement, i.e. the patient could get an out of pocket bill from the hospital, so we've done "quick look" freebies. HOWEVER, for private practice cardiologists who have built an entire infrastructure of ancillary personnel on the backs of echo reimbursement whose techs provide a wonderful service and who feed their families because of the reimbursement it garners, the issue of reimbursement should be considered as an important part of this technology. Less income from echo's spells fewer nurse practitioners in private practices whose owners are not salaried. So, fewer reimbursed echo's spells fewer RNP's, RN's and techs in our practices which mean that the 8 week wait to get in to see us stretches to even longer.
Our practices are now nothing more than a fragile house of cards whose livelihood depends upon uncertain reimbursement patterns. It's the dirty part of private practice cardiology but a very necessary issue that can be significantly impacted by advances in every area.
Melissa
I remeber a decade ago when we were all waiting for the laptop/portable ultrasound cart revolution. All of the "full-service" carts would be obsolete and "portable" would be the standard. Just as that predicted evolution never moved forward, I see this technology suffering a similar fate. Echo is far more than LV function and requires more than opposable thumbs to create quality images.
This is an amazing technology and I would love to have one to try. Its potential is very exciting. That said........Ultrasound is perhaps the most difficult of all imaging modalities. To suggest that physicians can learn to use this device optimally with a month or even 6 months of training is ludicrous. Even those highly skilled at interpretation would be unlikley to adequately obtain acceptable images. Studies show that nearly 15% of US exams are performed because of unreliable results from previous exams. While Medicare requires that all individuals performing an US exam is credentialled or the exam is performed in an accredited laboratory, unfortunately there is no enforcement. False positives would result in additional, unnecessary testing, increasing costs and potentially subjecting patients to invasive procedures. Patients with false negatives wold be perhaps the most unfortunate.
I would add the notion of patients scanning themselves and having a physician diagnose based upon those images is moronic. I hope there are no physicians out there willing to do so. Fortunately this device being an Medical Ultrasound device, by FDA regulation is only to be bought and used by Physicians and/or medical facilites. Hopefully this regulation will prevail, and the FDA will be granted the Teeth to be able to enforce it. The more products like this that are introduced, being so
small and (relatively) inexpensive the more you will see lay-person’s (like Tom
Cruise) try to be their own Doctor. They will be sadly mistaken once they try
and find they don’t know up from down. Now the next thing we need is
licensing which would require competency bar exams (ARDMS, CCI) in order to
practice. There are too many Psuedo-Sonographers out there already, we
don’t need every Joe Schmoe doing medical ultrasound too. The regulations Medicare currently has in place, only in select states BTW, have no real method of enforcement and only affect reimbursement, it is not a LAW that states in order to do Ultrasound you must be Registered, just in order to be reimbursed by medicare in certain states you must be, however, only 1 state that I know of audits this. This "practice" would just increase our already overburdened workload with unnecassary testing because “hey Doc I got this new toy and I saw this thingy and it really looks bad”. Firthermore, half of the Doctors that refer to us already don’t really know what they are looking for, we don’t need more nightmares. I do thinnk this could be a good tool however, in the right HANDS, of a trained Sonographer, if that "operator" is also a Doctor, that would be welcomed.
Trust me, I am all for more portable, more ergonomically structured diagnostic devices. However, if one imagines echo ever being as easy to perform as an ECG, one is grossly misguided. In the hands of skilled, credentialled and educated cardiac specialty sonographers, this new tool could be more than a toy. In inexperienced hands, this could destroy trust in the echocardiogram as a respected diagnostic exam. Experienced persons in cardiac ultrasound are fully aware of the subtle findings and doppler hemodynamics that constitute a full echo exam. Screening for the potential large perficardial effusion vs. the enlarged heart by CXR would be great. Thinking a patient could actually perform an echo on themselves, as opposed to placing electrodes on themselves for an ECG tracing, is ludicrous. I would like to see more of this new-sized technology, before I rule-in or rule-out its ability to perform a comprehensive echocardiogram. Of note, the image being shown to the audience on the new small screen device (taken from Topol's chest, I presume) and the subsequent enlarged image shown for comparison, are not one in the same. Patient safety and quality of care provided are of utmost importance. If new devices enhance our ability to provide safe, effective, quality care, then what's not to like? Thanks "KD," (above commentor), echo is indeed more than effusions and LV funciton. When an echo becomes something other than a hands-on, human dependent interaction between patient and skilled sonographer, maybe a patient will, in fact, be able to beam his/her own images wirelessly from home.
VScan & Diastolic Handgrip Exercise Using of an External Pressure Transducer: The 1st Pocket-Portable Stress Test device!..
Congratulations!.. Pocket sized will be soon the greatest challenge in Cardiology. I also believe that V scan will replace sthethoscope. It will help private practitioners with experience in echo to diagnoze Low LVEF, valvular/pericardial disease etc. However, I am somewhat sceptical about those colleagues without sufficient expertize; they could get too many "false positive" results.. Alternatively, V scan does not enable probably a detection of exercise -induced abnormalities, since hitherto only dynamic or pharmacologic stress tests are applied....We have showed in last 2 decades that using an external optimal pressurer transducer one can obtain transthoracically recordings (pressocardiograms) which mirror LV presure chnages in itime, slope and amplitude at rest and during Handgrip exercise. Pressocardiography during HG (Presso Test) can be combined with Doppler echocardiography for detecting characteristic LV diastolic abnormalities in pts with HG-induced ischemia as well as in HF pts with or without LVEF decrease. Thus, a "Combined Echo-Presso Handgrip Stress Test" would enable a pathophysiologically more optimal and correct assessment of LV diastolic behaviour and of PV changes. We have intriduced several combined Echo-Presso diastolic indexes in our published European Patent application (2009). A combined "ECHO-PRESSO probe" can also easily be developed for obtaining easier simultaneous echo- and pressocardiograms. We have also published some data comparing Dopler with pressocardiographic diastolic indexes during HG (Manolas et al., Cl Cardiol 2001). For example, ischemia induces an increasing pressocardiographi A wave and decreasing Doppler A velocity resulting in a dramatically increased ratio of these 2 variables as expression of latent, HG-inducible diastolic dysfunction (decreasing end-diastolic compliance) etc. Dr Topol: It would be exciting and useful to incorporate pressure transducer-derived recordings in the V scan device for introducing the "1st "Pocket Diastolic Stress Test" device..! It would enable a detection of ischemia and latent HG-inducible Lv diastolic dysfunction...
Very interesting, but i think that few clinicians are able to interpret correctly images obtained. ECHO is not as simple as most non-echocardiographers think. They´ll keep asking specialist opinion. Even good cardiologists sometimes have doubts, and it makes a very importante difference in conducting our patients. Congratulations for the study.
Incredible tool for bedside or outpatient checks of myocardial or valvular function. Really, the pictures displayed are impressive and tantalizing.
My concern is price for such a portable device. Somehow, I would have to tether it to my body so that I wouldn't leave it behind. Losing a $300 cell phone is painful. Leaving a $10,000 dollar echo machine in a patient's bed would be devastating.
I'd also be concerned about the "ruggedness" of the device. It hurts when you drop a laptop and the hard drive is damaged...but it is a $300 repair...the repairs to this device would be logarithmically inflated.
I was the first to introduce echocardiography at the Detroit Medical Center in 1973-74.
I was also expert in Auscultation and Phonocardiography.What a difference a few decades makes.
Absolutely, that's the way to go.
Guessing may be fun, but not the way to treat patients.
Now, here in La Jolla, CA, I am happy to see Dr Topol among us.
G.M. Hedayat,MD,FACC
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