Wells P N
Br J Radiol. 1986 Dec;59(708):1143-51. doi: 10.1259/0007-1285-59-708-1143.
Progress in diagnostic ultrasound is driven by the development of new technology. The place of new techniques in diagnostic algorithms has to be determined jointly by radiologists and clinicians and appropriate arrangements have to be made for training. About 30 million pounds per year is currently spent on diagnostic ultrasound in the UK. Diagnostic ultrasound depends on the information obtained as a result of ultrasonic irradiation of the patient. Biological effects, some of which are undesirable, can be produced by ultrasound but there is no evidence that the exposures used in diagnosis carry any risk. In judging whether ultrasonic scanning is appropriate in any particular situation, it is necessary to consider benefits, costs and available resources. The costs include not only the costs of the test but also the cost of any hypothetical ultrasonic hazard and the cost of misdiagnosis. The most prudent use of ultrasound is that which maximises the benefit-total-cost ratio and although this cannot presently be quantified, some of the concepts involved can be understood in terms of the health increment and the health decrement, the latter apparently being equal to zero when the diagnosis is correctly made using contemporary equipment. This approach can be extended to introduce the idea of profit arising from the test. As an example, obstetric ultrasound is considered to be appropriate when there is a medical indication for it. Although routine scanning at 16 weeks of pregnancy has been shown to result in a very large profit, there is still conflicting guidance about its advisability on the grounds of safety and existing accounting systems may restrict access to the profit. In discussing the desirability of ultrasonic scanning, patients can be informed that there is no reason to believe that there are any risks related to ultrasonic exposure. The imminent availability of inexpensive ultrasonic scanners for the layman is a worrying prospect to which the medical profession should now try to develop a prudent response.
诊断超声的进展是由新技术的发展推动的。新技术在诊断算法中的地位必须由放射科医生和临床医生共同确定，并必须为培训做出适当安排。目前英国每年在诊断超声方面的花费约为3000万英镑。诊断超声依赖于对患者进行超声照射所获得的信息。超声可能会产生一些不良的生物效应，但没有证据表明诊断中使用的超声照射会带来任何风险。在判断超声扫描在任何特定情况下是否合适时，有必要考虑益处、成本和可用资源。成本不仅包括检查的成本，还包括任何假设的超声危害成本和误诊成本。超声的最谨慎使用是使效益-总成本比最大化，尽管目前无法对此进行量化，但其中一些相关概念可以从健康增量和健康减量的角度来理解，当使用现代设备正确做出诊断时，后者显然等于零。这种方法可以扩展到引入检查所产生利润的概念。例如，当有医学指征时，产科超声被认为是合适的。尽管已证明在怀孕16周时进行常规扫描会带来非常大的利润，但关于其安全性的建议仍存在争议，而且现有的核算系统可能会限制获取利润。在讨论超声扫描的可取性时，可以告知患者没有理由相信超声照射存在任何风险。面向普通大众的廉价超声扫描仪即将问世，这是一个令人担忧的前景，医学界现在应该努力制定谨慎的应对措施。
