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The Rise of the Robots

Written by James Day, RDCS

Ever feel like a milkman talking on a payphone? I do. Just got this FDA announcement in my mailbox:

“FEB 07 2020
FDA authorizes Marketing of the first Cardiac Ultrasound Software that uses artificial intelligence to guide user.

Today, the U.S. Food and Drug Administration authorized marketing of software to assist medical professionals in the acquisition of cardiac ultrasound, or echocardiography, images. The software, called Caption Guidance, is an accessory to compatible diagnostic ultrasound systems and uses artificial intelligence to help the user capture images of a patient’s heart that are of acceptable diagnostic quality.”(1)

Now, one of the reasons I choose sonography as a career way back in 1994 (can you hear the ferns turning to coal in the background?) was because it was a talent, a skill, and not easily replicated. To me, the other Allied health careers were mostly button pushing or rote machinations. Sonography was attractive because not everyone could do it. It was all in the sonographer’s hands. Toss in, also, that you were the first to make a definitive diagnosis and it’s hard to beat sonography. Hard to get that PLAX view on axis? Are you sure you’re making accurate measurements in this aortic stenosis case? All skills most cardiac sonographers can easily handle… except now anyone can be good at it.

“In its review of this device application, the FDA evaluated data from two independent studies. In one study, 50 trained sonographers scanned patients, with and without the assistance of the Caption Guidance software. The sonographers were able to capture comparable diagnostic quality images in both settings. The other study involved training eight registered nurses who are not experts in sonography to use the Caption Guidance software and asking them to capture standard echocardiography images, followed by five cardiologists assessing the quality of the images acquired. The results showed that the Caption Guidance software enabled the registered nurses to acquire echocardiography images and videos of diagnostic quality.”(1)

Way back in 1994 while I was in sonography school, I came in from my rounds and saw about seven EKG technicians reading the paper, some doing their nails, and eating their breakfast. They had already made their rounds on the floors and were back relaxing in the break room on the Cardiac floor. “This is a great career,” I thought.

When I started my next year of ultrasound school, all but one EKG technician was gone.  They had trained the nurses to do the EKGs. Now I am reading that AI in its infancy will empower all advanced care providers using ultrasound to merely get near the various cardiac windows, move the probe around, capture many images, and the AI will sort through them and present the best possible on axis view.

Now I spent 3 months one summer in a clinical preceptorship learning cardiac ultrasound and grabbing hands-on scan time in order to acquire (probably the hardest of all ultrasound disciplines) cardiac images on axis. Those 500 or so cardiac studies are what made me a super sonographer who cardiologists trusted, and ED doctors called on. Now? With POCUS and now AI… not so much. I pull up a memory that harkens back to my college days and of a PASCAL class where we were mostly talking about the new computers and the professor wrote this on the board:

Agrarian -> Industrial -> Information

Let’s flesh out the above timeline, shall we? Industrial revolution and mechanization replaced the agrarian lifestyle we lived in for centuries. This began in the mid-1800s and continued for about 15 decades. In 1910, half of the workforce lived and worked on farms, and only 5% worked in professional and technical roles. By 2000, these numbers reversed to 7% of workers working on farms, in private households or as physical laborers, while 75% of people work in white collar jobs. During this 150-year transition, entire industries and jobs have disappeared; driven by rapid technology change. These jobs existed for centuries: farriers, tanneries, ice cutters, typesetters, blacksmith, and artisan crafters. More changes came in the 20th century, such as elevator operators, telephone switch board operators, and TV and VCR repair. The acceleration of change will be in decades – not centuries. The integration of intelligent machines will create and extinguish jobs and change our workplace. Experts claim that by 2030, automation, artificial intelligence, and machine learning will force about 32% of the American workforce (54 million people) to find new jobs. Globally, an estimated 60% of jobs today involve a subset of activities that could be taken over by automation. Going even further, a report by the Institute for the Future and Dell Technologies predicts that 85% of the jobs that will exist in 2030 haven’t been invented yet! (2) We will not have the luxury of a leisurely 150 years of change, it will be in 2 decades!

It’s happening now and fast, and in all medical imaging…


  1. Food and Drug Administration. (2020). “FDA Authorizes Marketing of First Cardiac Ultrasound Software That Uses Artificial Intelligence to Guide User.” Retrieved from https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-cardiac-ultrasound-software-uses-artificial-intelligence-guide-user
  2. Dell Technologies and Institute for the Future. (2017). “Realizing 2030: Dell Technologies Research Explores the Next Era of Human-Machine Partnerships.” Retrieved from https://www.delltechnologies.com/en-us/press/realizing-2030-dell-technologies-research-explores-the-next-era-of-human-machine-partnerships.htm

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