Ultrasound is the future. It's even better than that: it's the present. So say proponents Seth Koenig, Mangala Narasimhan and pioneer & innovator Paul Mayo in this month's CHEST review. They endorse a "paradigm shift" meaning, in effect, you get professionally trained on this highly versatile, effective, and immediate-results-providing modality and integrate it into your routine rounds and patient examinations. Why? You can diagnose things that begin with "P" without dependence on radiologists:

• Pneumonia (by seeing consolidation with air bronchograms), and lung abscesses

• Peripheral pulmonary masses; chest wall invasion by tumors

• Pleural effusions, with identification of loculations and/or atelectasis

• Pneumothorax, with the lung-point sign (or the absence of PTX, with the sliding-lung sign).

• Pulmonary edema, with B-line excess.

You can assess diaphragmatic function, and more safely and effectively perform thoracentesis, chest tube placement, or virtually any arterial or venous cannulation. You can make money from it, billing payers using codes like 76604 (ultrasound, chest: $100 if you own the machine), 76942  (ultrasound for needle placement: $200 using your machine), and 75989 (ultrasound guidance for percutaneous drainage). All without delays in study interpretation, calories, or ionizing radiation. However, you can't see structures (masses, mediastinal structures, etc) surrounded by well-aerated lung, which is anechoic. Machines cost $20,000, or $10,000 used, per the authors (who tastefully refer to them as "pre-owned"). Classes and ACCP certification (with travel) will run at least a few more thousand bucks. However, I don't know if you actually need certification to start billing for ultrasound. This excellent review gets you up to speed quickly and will allow you to get an impression of whether it's the right time to get on the ultrasonic train yet.

Koenig SJ et al. Thoracic Ultrasonography for the Pulmonary Specialist. CHEST 2011;140(5):1332-1341.