Melanie: Welcome to The GW HealthCast. I'm Melanie Cole, and I invite you to listen as we examine how point-of-care ultrasound impacts women in medicine. Joining me is Dr. Kat Ogle. She's an Assistant Professor of Emergency Medicine, the Director of the Ultrasound Fellowship, and the Medical Director of The GW Training Center and is affiliated with The George Washington University Hospital. Dr. Ogle, it's a pleasure to have you with us. I love this topic. So explain to the listeners, what is point-of-care ultrasound?

Dr. Kat Ogle: Of course, thank you so much for having me. So what listeners should understand is that point-of-care ultrasound is exactly that. It is ultrasound that we take to the bedside to diagnose very focused conditions. And for me as an emergency medicine physician, I use it on a daily basis on my patients in the emergency department.

Melanie: So tell us a little bit about some of the benefits of it. I mean, obviously you're taking it to the patient and ultrasound used to be a thing you had to make an appointment and go through the hospital and do the whole thing. Tell us a little bit about how this is working.

Dr. Kat Ogle: Of course. So a couple of ways in which it works for us in the emergency department is we can use it again, as I said, to diagnose very focused things. So for example, when a woman comes into the emergency department and she's pregnant, and she's concerned about her pregnancy, we can actually use the bedside ultrasound or point-of-care ultrasound to take a look at her uterus and her ovaries and make sure that her pregnancy is in the right spot and to make sure that there's no signs of internal bleeding.

Additionally, another thing that sometimes affects women is gallstones. And we can also use point- of-care ultrasound at the bedside to look at your gallbladder, to see if there are any signs of stones, to see if there are any signs of inflammation and things like that.

Melanie: Isn't that just amazing? Are there any downsides at all, doctor?

Dr. Kat Ogle: So I think the important thing is to make sure that the person who is using point-of-care ultrasound has had appropriate training. And anyone who is board-certified in emergency medicine is actually required to go through specific training in their residency in order to be credentialed to use bedside ultrasound.

And so during residency, we do a minimum of 150 scans of different kinds. We can do heart scans, we can do pelvic scans, we can do gallbladder, we can do kidneys, things like that. And that is supervised by a group of physicians in your training situation. And we make sure that people actually know what they're looking at. They are able to clearly identify anatomy. They can see normal things. They can see abnormal things. And once you've had this appropriate training, then you are what we call credentialed. And so having that credentialing and having that training makes it so that you are qualified to use this tool at the bedside.

As far as like limitations and whatnot, because it is a point-of care-tool, it is a very focused tool. So it's not designed to do-- for example, when a woman is pregnant and she moves on in her pregnancy and she's a little bit farther along, there's something that OB-GYNs do in collaboration with a trained sonographer called an anatomy scan. And the anatomy scan looks at very, very close details of the developing fetus. And that's not something that I do. I'm really there to say whether or not the, the heartbeat is appropriate, whether or not there are signs of internal bleeding and things like that. But I would say the limitation there is it is, it is not a comprehensive exam. It is a very focused exam.

Melanie: So it's not being used in the obstetrician-gynecologist's office just to keep track of normal proceedings during a pregnancy?

Dr. Kat Ogle: So that's actually a really good question. So a lot of OB-GYNs do use some point-of-care ultrasonography in their offices as a part of general assessment going through a patient's pregnancy. Um, But if they were having a, a more in-depth question about, for example, the anatomy of the, of the fetus, or they wanted to look at the placenta for blood flow and things like that, then they would send the patient for a more comprehensive study. But obstetricians do also use point-of-care ultrasound at the bedside.

I think the other thing that's very interesting is some of the things that obstetricians do for ultrasound, which would also be considered point-of-care, would be for procedural guidance for example. And so when people are putting in IUDs or they're trying to do , uh, different types of procedures to sort of take a look at the ovaries and take a look at the uterus, they may actually use point-of-care ultrasound in their practice as well.

Melanie: Technology always amazes me and it's just moving so quickly. Dr. Ogle, where does insurance stand for women that, you know, you're going to use this? You spoke about the training that's involved. Where does insurance stand on point-of-care ultrasound?

Dr. Kat Ogle: So that's a great question. So, because ultrasound that is used from a point-of-care standpoint is less detailed and less specific, the charge for such an exam is actually much less than what you would be charged for a comprehensive ultrasound. So for example, when we bill for a pelvic ultrasound that we do in the emergency department, the billing request for that is around $25 or $30.

And, when you do a comprehensive study again, because I'm not a radiologist and I don't go on that side of the billing structures, it's more expensive. But I would say the point-of-care ultrasound is certainly more fiscally , um, less expensive, shall we say, but it is covered by insurance.

Melanie: So tell me, doctor, as we're talking about point-of-care ultrasound, because this is really so interesting, where else do you see it being used? What physicians in different subspecialties can use it? What conditions and situations do you see this working? What's exciting for the future of this kind of technology?

Dr. Kat Ogle: Absolutely. So as technology has advanced, our ultrasound machines have gotten smaller and smaller. And there are now several handheld ultrasounds out on the market, which can either be hooked up to your cell phone or to a tablet. And they have software, which is incorporated there. And so we're actually seeing a trend moving into, not only primary care offices and family medicine offices and things like that, but also operationalizing it on a global scale for patients , um, who are in resource-limited settings. And so as we develop these training sessions and training programs for other specialties, you're actually going to see it being used in offices and whatnot.

In addition, it can be used to look at people's hearts, people's lungs, to look for any signs of internal bleeding throughout the entire abdomen regardless of the patient's gender. And I think we're also seeing some interesting uses, particularly as it relates to the coronavirus.

And so when we look at people's lungs, we look at their hearts, we can actually use that to direct our care at the bedside. And as I mentioned, when we, when we get our primary care physicians, going into the field using this, there will be some operations they'll be able to use it for in their offices as well, like looking for blood clots and looking for what we call abdominal aortic aneurysms, which is just a swelling of the main artery that comes out of the heart.

Melanie: I think that's so cool. So as we wrap up, Dr. Ogle, kind of reiterate about point-of-care ultrasound, what you want the listeners to know about how you're using it, how it impacts your clinical decision-making and how it's really affecting women in medicine.

Dr. Kat Ogle: So the things that the regular consumer or patient should understand about point-of-care ultrasound is it is a focused examination. It is applied by physicians and practitioners who have dedicated training for its use. It is designed to facilitate care particularly at the bedside. It's mobile. It has no radiation associated with it.

And the other thing to know is ask your physician who is applying point-of-care ultrasound how it is going to be incorporated into your care, because it's also important for you to understand how each of these things are interconnected.

Melanie: Thank you so much, Dr. Ogle, for coming on and telling us how this impacts women really in medicine. It's really an exciting time for technology. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Ogle or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. I'm Melanie Cole.