My career in 3.25 million clicks

Yoran Hummel | 30 November 2018

What if I asked you to do 3.250.000 clicks on any desktop, touchscreen or mouse? Your first reaction would probably be “Why?” 

Welcome to my world

When I welcome a patient into my echo room, I install both him (on the table) and myself (behind my echo machine).  Routinely, I check if I have the correct patient by double verifying his name and date of birth.  Once confirmed, I select the patient from the work list of my echo machine by double clicking on his name (2).  I scroll the pointer on my screen to the ‘height’ field and click (3), followed by 3 hits on the ‘ tab’ button of the key board of the E95 I use, to the field ‘weight’, followed by the 2D button (7).

Next, I put my probe on the patient and think “YES!  High quality images!”  Indeed after 18 years of working in the field of echocardiography my heart still makes a non-malignant jump when I get a nice and crispy echo image.

First things first, store a 3-5 cycle loop of the parasternal long axis view, by double clicking the store button (9), followed by another 40 loops and images, totaling another 40 times 2 clicks (89).  That’s all I need to provide a nice report.  I end the exam, by pushing ‘review’, ‘end exam’ reaching my 91st click.

Then, I shake my patient’s hand, give him instructions on where to go next and we courteously thank each other.

Approaching click 100

Now the real work starts as I sit down behind my echo reporting computer, hit the ‘refresh’ button (92) and see the newly added exam in the list, double click it (94) to open the exam.  The patient info screen pops up and I double click the first image I need for measurements (96).  Starting off, I skip to end-diastole by clicking on the EKG (97), optimizing the frame by two clicks (99), which frame I use to do dimensional measurements, then do the same to select end-systolic frame.  This process of frame selection is repeated on let’s say 3 different images, so 3 double clicks (105) to select the image I need, plus 3 clicks per end diastolic/end systolic frame (114).  On these 3 different images I do approximately 18 clicks for linear dimensional measurements (132), plus cavity tracing for volumetric measurements, adding up to 10 clicks per cavity, per view, adding up to another 60 clicks. (192)

And not done yet

Now on to doing measurements on the Doppler velocity profiles I stored of pulmonary- and aortic valve outflow, using point caliper this is an additional 2 click (194).  Luckily, no valvular regurgitation or stenosis (which would have dramatically increased the number of clicks on tracings of signals and color flow images.  However, this particular patient was referred with a NYHA 3 classification and increased NT-proBNP, hence I need to evaluate diastolic left ventricular function. Measuring E, A and DecT, e’ lateral and e’ septal takes me to another 3 double clicks for image selection and 5 clicks for the actual measurements.  So…we’re now up to 214 clicks, getting to the last stretch before I can finish my exam… interpreting and reporting!

I click the report page tab (215), after 18 years of interpreting echo’s and feeling fairly up-to-date on the most recent cut-off values of every single measurement I interpret the values.  LV mass index is 123 g/m2…ok, now I’m asking myself is that mild or moderate hypertrophia?  I catch myself in doubt, opening up the guideline on chamber quantification to check which, luckily, I have here on my desktop.  Still, it takes me one click to minimize the measuring software and two clicks to open the PDF (218).  After checking all measurements I performed in the exam and interpreting them, I start writing the conclusion of the exam.  I’m usually pretty short and straight to the point on this so let’s say 41 characters/clicks (249).  Feeling content with the result, I press ‘store report’, this last click pushes the total amount of clicks to 250.

Doing this repeatedly for, on average, 10 echoes per day, adding up to 2500 clicks per day…  Needless to say, people in this profession are at risk of RSI.

And it never ends

Funny fact: one of the most frequently described treatments, according to Wikipedia, is ultrasound treatment

Well, I recently discovered I’ve performed over 13k echo’s in my career in echocardiography, which adds up to > 3.25 million clicks!

What if we found a way to reduce the number of daily clicks by > 60%, getting rid of useless clicks, and making software more intuitive and supportive for its user? 

What if I press the end exam button after image acquisition reaching my 91st click, and then artificial intelligence took over and by the time I sat down to start interpreting and reporting, I see a report with all the measurements already there, clearly indicating which ones were re out of range…?  A report already containing a conclusion.

I would be dreaming…right?

Well, let me introduce you to!




(image courtesy of