The study by Dr Adler is interesting but the numbers are small, the outcome less than surprising and the limitations of the study are as mentioned. They were experienced operators and herein lies the problem. Good quality ultrasound will make an enormous difference to the quality of care in developing countries, but it requires months of dedicated training. The machines remain prohibitively expensive at the prices quoted (25-60.000 dollars)and suitable training is generally not available. Do not be fooled by commercial websites into buying even a cheap version of a portable machine if you do not have proper training. The results will be nothing like those of Dr Adler and his team. Rolling out ultrasound MUST concentrate on training, not the easy purchase of relatively expensive equipment.