Dawning of Another Golden Age for Ultrasound

Diagnostic ultrasound is an essential clinician’s tool. And, although it often does not get the attention (such as Nobel Prizes) of its sibling imaging modalities, it is the most utilized imaging modality in the world, depending on the metric.

The reasons why ultrasound is an essential tool are likely obvious to most readers of this blog. Ultrasound is relatively inexpensive, portable, and provides real-time imaging. It can be brought to patients who might otherwise be unable to receive imaging, whether that is because of the condition of the patient or the condition of the world around them. The variety and depth of our communities of practice attest to the robustness of this imaging modality (as does this blog, in its relatively short history). Furthermore, ultrasound imaging is not a static field; new technologies and applications, such as the use of artificial intelligence for COVID-19 diagnosis, are being incorporated on a continual basis.

Kevin Haworth, PhD, Cardiovascular

The American Institute of Ultrasound in Medicine (AIUM) has played a central role in the history and promotion of ultrasound imaging due to its membership. I would argue one of its greatest strengths is that the AIUM provides a home for anyone involved in ultrasound: sonographers, physicians, scientists, academicians, students, private practice providers, and industrial partners. There are a number of other professional societies associated with ultrasound imaging, but none that cover the same breadth of topics and people.

The AIUM has done this, in part, by stepping up to the openings before it. The AIUM has embraced a variety of opportunities to make a difference in the lives of patients, including decades ago with the advent of the ‘modern’ array and continuing to more recent capabilities including bedside POCUS, telehealth, and artificial intelligence.

Is the AIUM ready to continue its role as the preeminent home for all areas of ultrasound? Is it ready to fully embrace the dawning of another golden age for ultrasound – therapeutic ultrasound?

The field of therapeutic ultrasound has a rich history stretching back decades. What separates the current era from the past is the combination of technological advancements made and the pairing of these technologies with dedicated clinicians. Furthermore, the field has been accelerating as it learns from past successes to create future ones. One of the most notable initial advances was the use of ultrasound thermal ablation of uterine fibroids, which has been available to women in the United States since 2004. A number of companies have subsequently obtained FDA clearance, the European CE mark, or other equivalent regulatory approval for their ultrasound thermal ablation devices, enabling the treatment of a wide range of conditions.

In the past decade, reimbursement has also become available for ultrasound treatment of bone metastases and essential tremor. Most importantly though, the pipeline is rich with dozens of potential applications and hundreds of clinical trials. Importantly, the mechanism of action by which ultrasound can have a therapeutic effect has grown beyond thermal ablation, with clinical trials in blood-brain barrier disruption, ultrasound-mediated drug delivery, and mechanical tissue ablation (just to name a few).

The AIUM already has a number of our basic-scientist and clinician-scientist members making great contributions, particularly within the Basic Science & Instrumentation and Therapeutic Ultrasound Communities of Practice. However, to remain the preeminent home for all areas of ultrasound, we will need engagement from the entire broad and rich swath of expertise that our full membership community has to offer. There are important questions to answer, and I do not pretend to know the answers. I am confident, though, in the ability of our community to answer them. A few of the important questions for us to consider are:

  1. Just as there has been great opportunity in bringing together ultrasound imaging expertise across medical fields, do we see similar opportunity in being a home to bring together ultrasound therapy expertise across different medical fields?
  2. How do we make our society a welcoming place for therapeutic ultrasound clinicians who might not have the deep background in diagnostic ultrasound that is common of current AIUM members?
  3. How do we integrate our existing imaging expertise in helping to advance therapy, through treatment planning, guidance, and monitoring?
  4. How do we break down some of the silos between our existing communities, particularly the more discovery-oriented communities and the more practice-oriented communities?
  5. As we have played an important role in establishing standards, guidelines, and practice parameters in ultrasound imaging, should we do the same for therapeutic ultrasound?

The fundamental question, however, is: do we want to remain to be the American Institute of Ultrasound in Medicine, or do we want to be the American Institute of Ultrasound Imaging in Medicine?

Kevin Haworth (Twitter: @kevinhaworth) is an Associate Professor of Internal Medicine at the University of Cincinnati in Ohio.

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