As part of the 50th anniversary celebration of ACEP, Dr. Liu, chair of ACEP’s Emergency Ultrasound Section, interviewed Dr. Mandavia, a founding member and past chair of the section who now serves as chief medical officer of FUJIFILM SonoSite, Inc., a provider of point-of-care ultrasound machines. Here are some highlights from their conversation.

RL: How did you first get involved with ultrasound?

DM: In 1991, I started emergency medicine training at Los Angeles County University of Southern California Medical Center during the Los Angeles gang epidemic. We were overwhelmed with knife and gun injuries, car crashes, and other emergencies. The CT scanner was on the third floor, three football fields away, and patients often died in front of us with undetected internal bleeding or undetected cardiac tamponade, such as from a stab wound. It was a very frustrating experience.

One day, someone brought in a “miniature” ultrasound machine the size of a small refrigerator. I was fascinated that you could look below the skin and rapidly diagnose conditions we had no other way to detect. I was sold and spent my academic career teaching and publishing about point-of-care ultrasound.

RL: Your publications list literally models how we evolved into where we are today, with major landmark papers on bedside echocardiography and the Rapid Ultrasound in SHock (RUSH) exam. You also proposed some of the first models for physician training.

DM: At that time, I was one of the program directors, so it was my prerogative to require every resident to be trained in ultrasound. We were the first program in the country to do that. Now every U.S. emergency physician is trained in point-of-care ultrasound and dozens of other specialties also use it to improve patient safety, efficiency, and quality of care, while reducing the cost of care.

RL: What were your goals in setting up ACEP’s emergency ultrasound section?

DM: At the time, there were eight or 10 emergency physicians in the country using point-of-care ultrasound and we’d meet at ACEP annually. Working together was extremely valuable because there were a lot of educational hurdles and political barriers. In 1995, ACEP’s board of directors approved our proposal to start an emergency ultrasound section. That was a pivotal moment because the section became a dominant player in spreading and promoting point-of-care ultrasound.

RL: Tell us about your entrance into SonoSite and the premise behind the company.

DM: I joined SonoSite as a medical adviser in 2007 and subsequently became its chief medical officer. SonoSite has a very interesting heritage. In 1996, the Department of Defense awarded a Defense Advanced Research Projects Agency (DARPA) grant to ATL Laboratories (then a large ultrasound company based in the Seattle area) to develop the world’s first ultrasound for the battlefield. At that time devices were often 200 pounds and impractical for deployable military.

University of Washington researchers used very advanced, proprietary technologies, including digital conversion of ultrasound into an application-specific integrated circuit chip, to build a device weighing under six pounds. That was the birth of the SonoSite 180 machine, introduced on the market in 1998.

RL: What are some of the company’s milestones?

DM: We’ve introduced 12 products over 20 years in point-of-care ultrasound and have nearly 120,000 devices installed in 166 countries. We’ve been first to market with clamshell products, a fully operational one-handed system, and a wall-mounted system widely used in resuscitation bays and other locations. SonoSite was also first to market with an intuitive kiosk-based ultrasound system.

RL: What is SonoSite’s current focus?

DM: Our sole focus is point-of-care ultrasound with a guiding mission of “Any patient, anywhere, anytime.” It’s not just about miniaturization: The goal is to get an answer quickly and easily, so we spend a lot of time on user interface. If physicians are resuscitating a critical patient, the last thing they want is an ultrasound device that looks like the cockpit of the space shuttle. It has to be intuitive.

RL: What do you like most about working at SonoSite?

DM: I love that we’re trying to solve problems in health care. Every week, we get notes from physicians around the world about how clinical care has been impacted by point-of-care ultrasound, such as saving a patient’s life. That is extremely satisfying and motivating.

RL: How do you see point-of-care ultrasound and SonoSite’s collaboration with ACEP evolving in the future?

DM: Working with the ACEP ultrasound section has been a great partnership over the years and I think many more great things are going to happen. This technology is like the Swiss Army knife in medicine and its uses will continue to evolve. I love hearing from younger physicians who are discovering new applications. Ultimately, what drives me, what drives SonoSite, and what drives ACEP is improving patient care.

Dr. Liu is the director of point-of-care ultrasound education in the Yale School of Medicine in New Haven, Connecticut, where she also serves as assistant professor in t he department of emergency medicine and associate director of the section of emergency ultrasound. She is the current chair of the ACEP Emergency Ultrasound Section, and the immediate past president of the Academy of Emergency Ultrasound in the Society for Academic Emergency Medicine. (SAEM).

Dr. Mandavia is chief medical officer and senior vice president at FUJIFILM SonoSite, Inc. and FUJIFILM Medical Systems U.S.A., Inc. in Bothell, Washington. He is also clinical associate professor of emergency medicine at the University of Southern California in Los Angeles, and was an attending staff physician at Cedars-Sinai Medical Center in Los Angeles from 1998 to 2010. He is a founding member and past chair of the ACEP Ultrasound Section and co-author of the ACEP Ultrasound Guidelines.