Society of Diagnostic Medical Sonography

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2015 Annual Conference: Changing the World Through Sonography

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DALLAS, Texas - Medical care isn’t just difficult in some of the places Frank Miele, MSS, has visited, worked, and researched throughout his career. It’s nearly impossible.

In his plenary session Thursday at the 2015 SDMS Annual Meeting in Dallas, Miele offered staggering statistics focused on obstetrics in developing countries. “Changing the World Through Sonography” offered solutions about how imaging technology can drastically improve outcomes and reverse trends.

Miele told the audience that one in 24 women in Uganda die during childbirth. 
One doctor is available for every 25,000 people, and only one radiologist for every 2.4 million.

The World Health Organization reports that 800 women worldwide die every day because of complications during childbirth. Of those, 500 are in Sub-Saharian Africa.

Breaking down the numbers even more, Miele noted that about 40 percent of these deaths are from hemorrhaging and obstructed delivery.

“You get an idea of how ultrasound can change the world,” said Miele, a Dartmouth graduate and designer of ultrasound who lectures to sonographers, physicians, engineers, and students. "When you bring in ultrasound technology, you can identify these. And it draws people into clinics. If you’re bringing them in, you could do blood tests, you could detect anemia, hypertension, sepsis infection … you add these together, and you’re talking up to 60 percent of the cases."

Miele told the group of more than 1,000 sonographers that the advent of imaging in developing locations results in interesting issues regarding the appropriate use, education, cost, sustainability, and social, and medical ramifications. Two things, he said, make ultrasound a great option – cost and flexibility. Many of these underdeveloped countries have a road system that makes travel nearly impossible to a health clinic. Some have challenges just getting electricity to the area. Often, there are just too many people and not enough health care professionals.

“Ultrasound allows for local diagnosis,” he said. “You can bring it to them, and it has large range of applications. It’s ideally suited for the No. 1 issue in these areas – maternal health. The issue is sustainability. When you train people, they often move from the rural areas to the city because they can make more money. The other problem is the magnitude. When the need is so enormous, how do you scale it?”

Miele talked about several groups who have implemented ultrasound training programs in underdeveloped areas. The Project Vietnam Foundation, for example, trained a group of sonographers to perform up to U.S. standards. Nine were trained in OB and ultrasound physics, and all were able to demonstrate scan skills to complete an OB exam. One got RDMS certification.  Another group, Imaging the World, has created a new model that has significantly increased the number of women getting prenatal imaging and attended deliveries. 

“In the meantime, you’re teaching them about malaria, better post-natal care, involvement of the fathers,” he said.

It doesn’t come without challenges. He said in most cases, the groups found that you must have buy in from local physicians, and the trained technologists need a mentor to help with challenging cases. And when you implement a program, make sure you don’t dumb down the training. Patients deserve skill and competence.

Miele ended his session by showing a picture of a boy wearing torn clothes and a big smile.

“Whether he lives or not depends on us,” Miele said. “We can change the world."