Why We Need Ultrasound at the Bedside
From Farmlands to the Forefront of Medical Imaging
I joined the Air Force in December 1977, fresh from the farmlands of Idaho, to become a radiologic technologist. It was a leap of faith- and one of the best decisions I ever made. My first enlistment introduced me to diagnostic radiology and the second generation of Computerized Axial Tomography (CAT scan). As I wrapped up my service and prepared to continue my studies at Boise State, life took an unexpected turn.
A conversation with Colonel Hale, the Chief Radiologist at Wilford Hall Medical Center, changed my path. He recognized my passion for cross-sectional anatomy and offered me a chance to train in a new diagnostic imaging field called “ultrasound.” I saw the promise of this technology- and ended up signing on for another four years. In those early days, the real-time ultrasound machines weighed over 600 pounds and weren’t remotely portable. Despite these limitations, I knew we were onto something that could revolutionize patient care.
Modern Ultrasound: Versatility in the Palm of Your Hand
Fast-forward to today, and color-flow ultrasound technology has shrunk to the size of a laptop- or even smaller. Gone are the days of hauling around 600-pound behemoths; now, sonographers and clinicians can bring real-time imaging directly to a patient’s bedside.
While x-ray remains a staple for skeletal and many pulmonary conditions, ultrasound unlocks a different realm of possibilities:
Immediate Vascular Checks: Quickly locating and diagnosing life-threatening blood clots (DVT).
Cardiac Assessments: Evaluating heart function, checking ejection fraction, and identifying fluid around the heart- crucial details for urgent clinical decisions.
Abdominal Evaluations: Looking at the gallbladder, liver, and kidneys, or tracking down an abscess causing unexplained pain and fever- all without radiation exposure.
Despite these advantages, Medicare currently does not authorize portable imaging suppliers (Type #63) to provide ultrasound at a patient’s bedside, as they do with x-ray. Instead, patients are typically transported- often by ambulance or non-emergency transport—to a facility for ultrasound studies.
The P.U.R.E. Act: Closing the Gap
The Portable Ultrasound Reimbursement Equity (P.U.R.E.) Act (H.R. 2477, 119th Congress) is a legislative effort aiming to bring Medicare’s rules into the modern era by recognizing ultrasound as a reimbursable “portable imaging” service. This matters because:
Better Access, Less Stress Bedbound, elderly, or disabled patients would no longer need to endure the physical and emotional toll of transportation; instead, the ultrasound and the technologist would come to them.
Significant Cost Savings Medicare would cover transporting the equipment- not the patient- substantially reducing expensive ambulance trips and easing congestion in emergency departments.
Enhanced Diagnostic Capabilities Beyond skeletal and pulmonary issues, portable ultrasound can detect vascular and cardiac problems, abdominal anomalies, and more—all in one bedside visit.
Timely, Compassionate Care Patients in hospice, palliative, or home health care settings can remain in familiar surroundings, reflecting the same compassionate approach already taken with portable x-ray.
A Vision of Comprehensive Portable Imaging
In my 47 years in the imaging field, I’ve witnessed the profound impact of bedside x-ray services on patient outcomes and healthcare costs. Now it’s time to extend that same level of patient-centered care to ultrasound.
By supporting and passing the P.U.R.E. Act, Congress can update an outdated Medicare definition that unintentionally denies some of our most vulnerable patients timely access to one of medicine’s most powerful diagnostic tools. The payoff is clear: fewer unnecessary transports, faster diagnoses, and better continuity of care for millions of Medicare beneficiaries.
In Closing
Just as the simple AP chest x-ray remains a cornerstone of bedside care, portable ultrasound can join the toolkit- if we allow policy to catch up with technology. If you believe in compassionate, on-site care that puts patients first, I urge you to learn more about the P.U.R.E. Act and advocate for its passage.
Together, we can help Medicare keep pace with innovation, delivering high-quality, dignified care to those who need it most- right where they need it.
For more information on portable imaging or the P.U.R.E. Act, please reach out or visit aisxray.com and apdahealth.com
