1. Owens, Darrell PhD, RN, CHPN

Article Content

R.A.L.E. Lung Sounds 3.0 PixSoft, Inc. 208-3111 Portage Ave Winnipeg, Manitoba, R3K 0W4, Canada Telephone: 204-885-4936 E-mail: Web: Price: $49 download version; $59 CD-ROM individual, $195 CD-ROM institutional


This CD-ROM software program provides the user with the opportunity to learn both vesicular and adventitious breath sounds. The program reviews the basic fundamentals of acoustics and hearing, anatomy and physiology of the ear, and pathophysiology related to certain pulmonary disorders. The program is written in textbook format, and each section provides both sound and visual graphics. The sound graphics are excellent. The program is simple to install and easy to navigate. An additional feature allows users with Internet access the ability to link directly to various reference Web sites. These links occur throughout the program and provide users with the option to obtain information that is beyond the scope of the text.


Although the reviewer did not need it, the program's "Help" menu is of limited value, in that it only redirects the user to the "Instructions" section of the text. It does not provide the user with the opportunity to ask questions. However, the "Instructions" page provides clear, concise, and easy-to-read instructions for program use. Technical support is available via telephone, Web site, and e-mail. When using the program, the text content will be on the right of the screen with corresponding visual graphics on the left. The user can progress through the material at his or her own pace, using either the Page Down or down arrow (->) key. The auditory component is one of the most important elements of the program. To receive the maximum benefit of this component, the user will need a computer with a sound card and good speakers or headphones.


The first chapter, titled "Acoustics," provides a basic overview of the physics of sound and hearing. The initial information in this chapter is very detailed and technical. The content includes frequency and intensity of sound, low-frequency perception, harmonics and overtones, noise, and pitch perception. Although the associated graphics provide useful visual and auditory learning aids, at times the content is difficult to grasp due to its technical nature. Users should not be worried if they do not develop a thorough understanding of this initial section. A detailed understanding of the concepts of decibel, Hertz, wavelength, and so forth is not required to benefit from the remainder of the program. Also included in this chapter is a basic review of ear and chest anatomy, the physiology of hearing, and a brief section on the components of the stethoscope. The information in this section is less technical and is easy to comprehend, and should be more familiar to the user.


The second chapter, "Basics," covers normal breath sounds, adventitious sounds (wheezes and crackles), and other sounds (stridor, grunting, squeaks and squawks, and friction rub). Again, headphones or high-quality speakers are required to receive the full benefit of this section. It is further recommended that if users do not have access to headphones, they complete the program in a quiet environment. The first section, normal breath sounds, provides a detailed but easy to understand explanation of normal/vesicular breath sounds. The corresponding sound component enhances the learning process by providing examples that are clear and realistic. The visual graphics, while clear, are not as helpful to the learning process as they again relate to frequency, amplitude, and decibels. The most useful component of the visual graphics is the inspiration/expiration flow chart located at the top of the screen. The program is written in a manner that allows the user to repeat sound examples as often as needed without disrupting content flow.


The next section covers adventitious sounds. The text and corresponding sound graphics in this section are outstanding. The content, although detailed, is clearly written and easy to comprehend. Wheezes and crackles, the two most common adventitious lung sounds, are covered in significant detail. Numerous clear and realistic sound examples of both adult and pediatric patients are provided. The program allows the user to move between current and previous sounds without extensive scrolling back and forth. This feature facilitates learning by allowing for easy comparison of breath sounds. The final section of this chapter covers several other breath sounds, including stridor, grunting, squawks and squeaks, and friction rub. Again, the program is detailed, but concise, and provides easily comprehended information. The sound examples are once again clear and realistic, and allow for comparison. As with the prior section, the visual graphics, other than the flow chart, do not enhance the learning process.


The final chapter, "Cases," includes 6 different case studies. The case studies include asthma, wheezy infants, pneumonia, interstitial fibrosis, noisy breathing, and foreign body aspiration. This chapter allows for the practical application of material learned in preceding chapters. Each case study succinctly covers pathophysiology as it applies to the breath sounds being heard, and allows for comparison between different cases. Once again, it is the clear and realistic sound examples that make the case studies effective learning tools. Also consistent in this chapter is the minimal contribution of the visual graphics. The program includes several "Self-Assessment Quizzes" with questions that accurately reflect the content. The questions, which are in both audio and written format, are well constructed. The user is provided with the correct response and corresponding explanation at the end of each quiz.


The R.A.L.E. Lung Sound 3.0 edition is both informative and user friendly. The program is an excellent tool for learning vesicular and adventitious lung sounds. The content, other than Chapter 1, is clear, concise, and well written; however, it is the auditory component of the program that makes it an exceptional teaching and learning tool. This program would be useful for nurses desiring to gain or improve their knowledge and skill related to lung sounds, as well as for those who simply want a refresher. In addition to the text, the reference list provides current resources for those desiring information beyond the scope of the program. This program would be a valuable and cost-effective addition to a nursing program's continuing education library.


Minimum System Requirements: 486-66 mHz or Pentium processor; 15 MB RAM; Windows 95, 98, 2000, NT (not available for Macintosh); any Windows-compatible 16-bit sound card; headphones or stereo speakers; SVGA or LCD color display; mouse; CD-ROM drive for those who purchase the CD-ROM; Internet access for those desiring to purchase the program via download at, and/or to utilize Web-based reference material.