Podcast Interview: Echocardiography in Research, Practice, and Education

“How do [these AI tools] affect physicians' decision-making, confidence, and ordering practices? More importantly, how do they impact patient outcomes? We are just beginning to explore these questions, and testing is essential to determine which AI tools work best and how to implement them effectively.”

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Heart disease remains the leading cause of death worldwide, but advancements in echocardiography are revolutionizing diagnosis and treatment. In this episode, we explore how cutting-edge research and technology are shaping the future of cardiac care. Joining us is Dr. Jordan Strom, Associate Professor of Medicine at Harvard Medical School and leading expert in echocardiography.

Emmanuel Soto: What do you see as the most impactful innovations in improving diagnostic accuracy and patient care?

Dr. Jordan Strom: I'm a little biased because, from the outset, we use about 30 to 40% contrast in our lab, and we are strong advocates of contrast. I sit on the International Contrast Ultrasound Society Board, and I believe contrast is a central yet underutilized piece of the equation. We know that only about 6.8% of all outpatient echocardiograms receive contrast, while 10 to 20% are suboptimal—meaning they could potentially benefit from contrast. So, there's a clear deficit, and this varies based on location. For example, if you walk into a hospital in Delaware, you have a 1% chance of receiving contrast, whereas in Minnesota, the same patient would have a 30 to 40% chance. There are significant discrepancies in the use of these agents.

Looking ahead, there are many potential applications for so-called theranostics, where contrast agents—microbubbles—not only help identify structures in the heart but can also be linked to specific drugs or antibodies, enabling targeted molecular imaging and precise therapeutic delivery. To fully harness this potential, we need specialists in the echo lab who understand how to best utilize these technologies, study them, and assess their impact on patient care.

Of course, I would be remiss if I didn’t mention AI. Much of my work, as well as that of others, revolves around AI. It has been revolutionary across many fields, including medical technology and imaging. However, its effectiveness depends on the input data. We've processed claims data through complex machine learning algorithms, yet sometimes the results are no better than those from a simple statistical model. Why? Because conditions like diabetes are not simply a one or a zero—they exist on a spectrum. The nuances of disease can get lost when we force data to fit predefined models, particularly when nonlinear associations exist.

AI excels when applied to audio-visual data, such as video clips from echocardiography. Convolutional neural networks and deep learning algorithms can be highly effective at classifying disease. The challenge now is integrating these tools into clinical practice. How do they affect physicians' decision-making, confidence, and ordering practices? More importantly, how do they impact patient outcomes? We are just beginning to explore these questions, and testing is essential to determine which AI tools work best and how to implement them effectively.

Another critical challenge is ensuring AI tools are generalizable. If an algorithm works only for patients from one medical center but not others, its usefulness is limited. We need to validate AI across diverse populations—across different races, ethnicities, and genders—to avoid introducing bias into patient care. Data sharing is key to achieving this goal. To make AI tools truly impactful, they must be trained on data that reflect the diversity of the patient populations we serve.

Emmanuel Soto: What other major challenges have you observed in sonography education and accreditation?

Dr. Jordan Strom: In the field of sonography education, my role spans multiple areas. I direct sonographers in our own lab, oversee training for sonography students at clinical sites, and serve as Medical Director for the Massachusetts College of Pharmacy and Health Sciences’ Echo Training Program. Additionally, through the JRCDMS, which accredits sonography schools nationwide, I have insight into sonography education at both the institutional and national levels.

Not all sonography programs are created equal—some excel, while others struggle. One of the biggest challenges limiting program expansion is the availability of robust clinical training sites. Students often have to travel significant distances to access diverse clinical experiences. Classroom learning is important, but hands-on patient interactions are essential for mastering sonography. The best programs integrate both strong didactic training and hands-on clinical experience.

Another pressing issue is the national sonographer shortage. According to the most recent AAC Trend Survey, 70% of institutions report sonographer shortages—a number that has been steadily rising since the pandemic. While many aspects of healthcare have improved post-pandemic, sonographers have been leaving the field in large numbers, creating a staffing crisis. Without enough sonographers, we cannot provide the level of patient care we aspire to, nor can we ensure timely access to echocardiograms.

Part of the solution lies in recognizing the critical role that sonographers play. They are not just technicians; they are essential colleagues and co-equals in patient care. Addressing the shortage requires strengthening the foundation of sonography education, expanding outreach to high school students, and increasing awareness of sonography as a rewarding healthcare career. Efforts like yours—reaching out to individuals considering careers in healthcare—are crucial. Sonography offers direct patient interaction, the ability to make a real impact on patient outcomes, and opportunities for professional growth. By raising awareness and investing in training, we can attract more talented individuals into the field and secure the future of sonography.