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Office ultrasound - Ärzteforum

Post#1 »

My partner and I just came back from the ACS spring meeting where we both took the Ultrasound for Surgeons course. I thought the instruction was quite good, and the price was especially low for a course of this type. We have decided to buy an ultrasound machine for our office (we have a large breast and thyroid practice, among other things). We, and the others that have attended the course have also pressured the hospital administration to place an ultrasound machine in ou ER; something that should have been done a few years ago.

The question that I have for you is does anyone have any experience with "lower end machines"? By that I mean a plain old machine at a reasonable cost (17-35K) that is intended for office work? I would be especially interested in anyone having NEGATIVE comments about any of the machines, their service, their warranties, etc.


Re: Office ultrasound - Ärzteforum

Post#2 »

No comments to help you with a value machine, but just an encouragement for doing what I feel is an excellent thing. I think we surgeons should all be at ease with USScanning especially abdominal, and think it should be part of our regular training. Interestingly many pioneering interventional radiologists are ex surgeons - who better to have a good feel for the anatomy they are imaging. We hope to get an USScan in our emergency room for use with acute trauma and non trauma abdomens soon, and think it will be of great value. Interestingly there are even a few radiologists who agree (though when I voiced some of these sentiments at the recent Irish College meeting in Durban it seems Irish radiologists weren't so keen).


Re: Office ultrasound - Ärzteforum

Post#3 »

I became convinced of the importance of office ultrasound about two years ago. I was limited in space in my office. I wanted a machine that I could easily move from one exam room to another. I also wanted to be able to use the machine immediately without haivng to wait for it to boot up.

Most of the machines I looked at then obviously were not designed with portability in mind. I ended up with a Hitachi EUB-405 Plus unit. It takes only a few seconds to be ready for use. It is very portable. It cost me about $34,000; perhaps they are less now. I only have one probe, a 7.5mHz. Over 90% of my use is for breast lesions, the rest for thyroid and "miscellaneous" problems, such as subcutaneous nodules, lymph nodes, ?hernias. About once every 2-3 months I will be wishing I had a 3.5 mHz probe for abdominal studies, but it just doesn't seem worth the extra $5-7,000.

Obviously, ability to recover the cost of the machine was a big concern to me, but this has ended up being no problem. I will frequently use it at no charge to the patient or insurance company if it's use in a particular situation is questionable.

As far as service is concerned, I haven't had any service problems so I can't say for sure. But the machine has certainly been reliable. Our hospital just purchased a similar unit with a different probe for our Er trauma cases.


Re: Office ultrasound - Ärzteforum

Post#4 »

My partner and I purchased a dedicated ultrasound unit 2 years ago and use it as you do--90% breast, 5-7% thyroid, and 3-5% miscelaneous. We, too, have only a 7.5 MH transducer, but find it very adequate. Our unit is made by Acoustic Imaging and has proven to be very dependable and reliable. We have not had to have a single service call except for the power cord which became frayed, and it was repaired easily for $30. We can't imagine a breast practice without our own ultrasound. We diagnose about 80% of our breast cancers in our office at the first office visit with US assisted needle biopsy (FNA and Core). Our patients love it and we love it. I'm sure the insurance companies also love it, but we get no "points" for saving them many $. We also do many "no charge" ultrasound examinations. We don't charge if a patient comes to the office with an ultrasound in hand, although it is worthless to us. We don't feel right in charging again, so we do our procedure for free. We do charge for the biopsy, if we do it. It is my opinion that primary care physicians should not send patients to radiologists for ultrasound exams unless the radiologists are skilled at interventional ultrasound procedures. It makes no sense to get an ultrasound exam by a technologist, have it interpreted by a radiologist at great expense, then send the patient to a surgeon. The surgeon should be prepared to use his or her knowledge of breast disease to use ultrasound appropriately in the office setting. This would avoid unnecessary duplication of services and, more importantly, do what is most appropriate and convenient for our patients!

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Re: Office ultrasound - Ärzteforum

Post#5 »

We get a lot of use from our B&K ultrasound machine. We have a multi frequency probe (8 - 5 mhz) but do almost exclusively breast.

Question: When a patient requires an ultrasound guided biopsy, is it done on that initial visit or do they return? Do you set aside time to do ultrasound guided biopsies on the initial visit?

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A Doctor

Re: Office ultrasound - Ärzteforum

Post#6 »

We, too, purchased an ultrasound unit for our practice and use it as described above. I find that I'm using it less and less. Most of my patients have a palpable mass - you don't need an ultrasound to do a FNA or cyst aspiration on it.

Amazing how much business the radiologists are getting for palpable masses.

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Re: Office ultrasound - Ärzteforum

Post#7 »

I try to do the ultrasound guided biopsy at the initial visit, and it is usually possible--unless I am hopelessly behind schedule. I've found that I can counsel a patient in about 5 minutes, and do a FNA in another 5 minutes. A core biopsy takes a bit longer, but my nursing staff has learned to make it a quite efficient procedure. And my patients are very grateful for the convience of "one stop shopping".

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Re: Office ultrasound - Ärzteforum

Post#8 »

I urge your to use ultrasound on palpable masses, too. Direct your biopsy needle to the hypoechoic area of the mass--your yield will be much greater than doing it by feel. Also, how many times have your taken a patient to the OR for an unsuccessfull aspiratio of a cyst only to find a cyst? It won't happen if you use ultrasound to guide your aspiration.

Grandpa Phil

Re: Office ultrasound - Ärzteforum

Post#9 »

Archives of Surgery, pp. 504-508, article titled A Prospective Analysis of office-based breast ultrasound This should be a study you will embrace with typical knee-jerk enthusiasm, but I wonder if you could provide us with an honest critical analysis of this study from the perspective of one who uses office ultrasound?

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Old surgeon

Re: Office ultrasound - Ärzteforum

Post#10 »

I have read the article and thought it made a few good points. It raised a few questions in my mind, and I plan to read it more critically. I'll follow up with my thoughts in the near future.

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