Shortness of breath is one of the most common presenting symptoms to the emergency room or urgent care centers. The underlying cause is a myriad of different conditions and the likelihood of each highly dependent on the patient demographics and time of year. That being said, our diagnostic response is very consistent and more attached to the historical norm than the factual accuracy of the tests administered: the shortness-of-breath chest X-ray reflex.
Physicians pride themselves on delivering the highest quality, evidence-based care, yet we often resist changing well-worn practices. The continued reliance on chest X-rays when a patient presents with respiratory symptoms perfectly illustrates this paradox. X-ray has well-known limitations: inaccuracy for various conditions, radiation exposure, and the delayed response of some conditions to appear on the X-ray. This is particularly troublesome when physicians put so much reliance on its results.
This attachment to familiar tools isn’t unique to imaging—it’s a pattern we see throughout medicine. But in an era of rapid technological advances and evolving patient needs, this mindset needs to change. Tools like point-of-care ultrasound (POCUS) are now widely available, enabling more precise and immediate lung scans. The diagnostic accuracy of lung ultrasound dwarfs the same for chest X-ray across most important conditions by such a wide margin, it almost defies understanding why we are so slow to adopt this new approach.
The clinical data on lung ultrasound is available but training, education and the need for practice, competence and confidence, as well as the availability of devices, has previously stood in the way of adoption. However, new, more affordable and versatile, all-in-one solutions like the Butterfly iQ3 are helping physicians upgrade their diagnostic approach with portable, advanced imaging that reduces reliance on traditional methods.
With these innovations, we have the chance to transform our standard of care and embrace the future of medicine.
The challenge of change in medicine
As a surgeon myself, I often ask myself: Why are us doctors so hesitant to try new approaches, even when the research shows they work better? It’s complicated. When you’ve spent years mastering a particular way of doing things, it’s tough to step outside that comfort zone. And the fact that institutions are built around established processes can make any change feel like upsetting the apple cart.
This past winter’s flood of respiratory infections drives this point home. Kids and adults were sitting in emergency rooms for hours waiting to be seen, get X-rays done and learn the results. Imagine a world in which instead, a care provider in triage performs a lung ultrasound alongside taking initial vital signs. So often the diagnosis would be clear and an accelerated path to treatment could begin. This isn’t a hypothetical situation; a team in Indiana put ultrasound on the ambulance and used it for suspect heart failure. The time to treatment was reduced from 169 minutes to 21 minutes, a staggering reduction. Imagine for a moment what it is like for a patient to reduce the time they are struggling to breathe by over two hours, not to mention what impact that has on emergency department throughput and cost.
The time has come to shift from X-rays to bedside ultrasound. The research is clear: robust, peer-reviewed evidence shows ultrasound is better than X-rays for checking lungs – it’s faster, more efficient and more accurate. Other reviewed research has demonstrated that after being examined using POCUS, 92% of patients felt more thoroughly examined, 85% felt they had been taken more seriously and 86% felt more secure. During seasonal outbreaks, doctors found that these portable ultrasounds were giving them results as reliable as CT scans, right at the patient’s bedside, helping clinicians determine much sooner if certain conditions are at play.
Beyond clinical benefits, the shift from X-ray to POCUS also drives economic value by enhancing the workflow and efficiency of the lung exam. According to the World Health Organization, chest X-rays constitute 40% of the $3.6 billion spent annually on imaging. Additionally, the use of lung ultrasound on patients experiencing congestive heart failure can predict who is more likely to be readmitted. With average CHF readmission rates at approximately 25%, at a cost of $16,000 to $20,000 each, the potential savings quickly become significant.
What’s more, while ultrasound can be an intimidating imaging modality to approach, lung ultrasound happens to be one of the easiest scans to learn. Most healthcare providers can pick up basic lung ultrasound skills after just one training course and seeing a handful of patients under supervision. It shows that staying on top of your game in medicine means being ready to learn new tricks, no matter how long you’ve been practicing.
Learning from past transitions
History offers many examples of successful paradigm shifts in medicine. Consider the transition from open to laparoscopic surgery in the 1990s. Initially met with skepticism, minimally invasive techniques are now the standard of care for many procedures. Similarly, the shift from film to digital radiography faced resistance but ultimately transformed medical imaging. These transitions fundamentally altered how procedures were performed and taught.
These big shifts in medicine happened because the evidence was solid, key people pushed for change and hospitals had a plan to make it work. The practitioners who jumped in early and tried these new methods often ended up leaders in their fields, while those who dug in their heels got left behind in giving their patients the best possible care.
A culture of continuous improvement
For healthcare to advance, we need to cultivate environments where questioning established practices is encouraged and professional growth is prioritized. This means:
- Normalizing lifelong learning – Healthcare organizations should create structured opportunities for providers to learn new techniques and technologies, making skill development a core part of professional practice rather than an optional add-on.
- Supporting evidence-based change – When research demonstrates better approaches, healthcare systems need to evaluate and implement the improvements that will benefit their workforce and patients.
- Fostering champions of innovation –Identify and support clinicians who can guide colleagues through changes, sharing both technical expertise and managerial strategies for adopting new methods.
As we face respiratory challenges, we have an opportunity to show how medicine can progress. The shift from chest X-rays to POCUS is about more than adopting new technologies over outdated methods: it’s about embracing a mindset that prioritizes continuous improvement over comfortable routine.
Every established medical practice was once new and uncertain. The question isn’t whether we should evolve, but how we can do so thoughtfully and effectively. Our patients deserve nothing less than our commitment to constant growth and improvement, even when it means questioning “the way we’ve always done it.”
Dr. John Martin
Dr. John Martin is the Chief Medical Officer of Butterfly Network, a transformational medical device company that is democratizing medical imaging across the globe.Dr. Martin completed a residency in general surgery and vascular surgery at Parkland Memorial Hospital in Dallas, Texas.
He is board certified in vascular surgery and a Fellow of the American College of Surgeons. He served in the United States Air Force for 7 years first as a corpsman and then after completing medical school and training he returned as a Surgeon.
He is the founder and President of the Heart Health Foundation and the award-winning Dare to CARE Program. He is the author of multiple peer reviewed papers and book chapters, holds several patents and developed clinical software used across the country.
