United Medical Instruments - Diagnostic Ultrasound Blog!

Part I

Men have them, women have them, in fact, one in three adults over the age of 50 suffers from varicose vein issues. Over the next two weeks we will look at the types of treatments available, equipment needed and recent studies comparing the procedures.

In a discussion with Registered Phlebology Sonographer, Jeanette Ashby, she explains varicose veins like this "Varicose veins are large, misshapen veins, primarily found in the ankles, legs and thighs. They occur most frequently in women, but they do affect men as well. When a vein is functioning normally the valve pumps blood towards the heart. Varicose veins form when the vein becomes damaged, usually when the vein wall weakens and/or the valves in the vein become faulty. When the valve becomes damaged it is no longer able to pump all of the blood towards the heart and blood "pools" in the vein. As a varicose vein enlarges it will contain larger volumes of blood, thus putting even greater pressure on the one way valve below."

To treat varicose veins there are conservative or active procedures to implement, depending on the patient and training/background of the physician. The conservative approach includes:

• Compression Stockings – This treatment is effective in reducing the swelling and pain associated with varicose veins by reducing the venous volume and shifting the flow to other parts of the body, compression stockings combined with exercise of the calves can alleviate minor issues, but studies have found there is poor compliance.

• Leg Elevation – Keeping the legs above the heart may also relieve some of the symptoms

• Medications - Ibuprofen or aspirin can also be prescribed in some cases to relieve occasional swelling

Next week we will dive further into the various invasive procedures involved. For a sneak peak of what's ahead, listen and watch Dr. Chuback explain Endovenous Laser Treatment. To see which portable ultrasound systems can meet the needs of your venous procedures, click here.

As the industry for compact ultrasound systems continues to grow, physicians who want to purchase their first ultrasound or trade out a bulky cart-based unit for a laptop sized one, have plenty of options.  Although buying new has its rewards, such as a 5 year warranty from SonoSite, this is a recession after all, and many people, physicians included, are on a budget.  According to imaging trend watcher Harvey Klein, PhD, with Klein Biomedical Consultants, "The compact ultrasound market continues to be the largest segment of the overall ultrasound market in the U.S."  Just like buying a used car, there are risks, but here are 4 tips to buying refurbished or used ultrasound equipment to help you mitigate potential issues during your buying process:

1. Commitment to Quality

What is their process for repair and warranty work?  What is their process for refurbishing the ultrasound equipment? Whether it's just an additional transducer you need or a fully loaded laptop ultrasound system, do they just paint the nicks and send it out the door or is there a comprehensive checklist including safety points that are reviewed?

2. Scope of Resources

How many people work at the company, is it a broker working from his house?  Or will you receive post sale support in the form of onsite training, continued lifetime online training for new staff?  Do they repair the equipment in-house or source it to another company?

3. Price

This is a tricky area and one where you need to make SURE you are comparing apples to apples, not an apple to a grape.  If it seems too good to be true, guess what?  It is!  Make sure you have a quote that details which features are enabled on the system you are going to purchase and that if you have requested a linear transducer for vascular access you are looking at two identical descriptions - there are multiple linear probes from SonoSite for example and they are different.

4. References/Reputation/Relationships

This is either an area you can start with, asking colleagues for references, or end with.... check the website, are there testimonials from past customers?  Can you talk with a customer about their experience?  Online resources such as Dotmed.com post feedback about resellers, be educated about who you are working with.

Get on board and join the millions of physicians who are using portable ultrasound for applications ranging from vascular to MSK to Family Practice.

Get the facts today about buying used or refurbished ultrasound machines - download our Guide today!
 

So you have a new laptop ultrasound system in your private practice, great, but how do you market yourself in your community? Ultrasound is a versatile and affordable modality that is changing the way physicians treat patients. Private practice clinicians are incorporating ultrasound for a range of specialties from breast imaging to AAA screenings to ultrasound guided joint injections and in-office biopsies. As physicians look to treat the whole patient and conduct preventive screenings, marketing yourself as a resource is paramount. Following are some social media ideas to incorporate into your marketing plan when promoting ultrasound at your office:

1. Facebook. You do not need to post your daily trip to the coffee shop or give hourly status updates that frankly, not many people care about, but what you DO need to have is a Facebook Fan Page, and this is assuming you have a website which is imperative to the success of every business at this point. Use the Facebook Fan Page to promote happenings at your clinic (health screenings or free baby face scan), relevant articles for your patient population, comment section for patients to provide feedback about the care and service received. Facebook is also a very economical tool for targeted ad campaigns to reach potential patients. For example, September is National Prostate and Ovarian Cancer month, create a demographic-specific ad to draw attention to your practice and the ultrasound services you provide centered around these topics.

2. Yelp or Healthgrades. When anyone does research when making a purchase or taking a trip, the internet and Google are the first-stop in that journey. The same is true, if not more true, when researching a doctor. Reading reviews of the physician, their practice and services offered drive the decision making process to make the appointment or move on. Ensure you have available content on sites your potential patients are perusing and check them yourself for positive or negative comments so that you can manage your reputation accordingly.

3. YouTube. Video testimonials are powerful and allow access to real patients. Ensuring all HIPAA laws are followed, you might consider interviewing a few patients and highlight their experience at your practice. Post these on your website to help keep your site fresh, dynamic and up top in Google search results.

Ownership of portable ultrasound equipment is on the rise, if you have a system in your practice, make sure your patients know how you can help them! To learn more about ultrasound and joint injections click here.

 Part I

Welcome to the first installment of Jeanette's Journeys! Jeanette is the National Marketing Manager for United Medical Instruments, Inc. and not only gives stellar product training to the sales reps, but also travels to customer sites addressing questions, providing SonoSite, Toshiba, and Siemens ultrasound system training, as well as ensuring customers are completely happy with their ultrasound purchase. When not involved at a customer site or developing marketing programs, you can find her at a tradeshow. She is a major contributor to the success of UMI, and hopefully you enjoy reading our blogs based on Jeanette's Journeys!

East Coast Sales Director, Jerry Michel, consulted with Virginia Vascular Surgical Center to determine which SonoSite portable ultrasound system would meet the needs of this friendly yet busy Davita Dialysis Center. Post sale customer support was requested to address the customer concerns of:

• Performing flow volume exams
• Identifying shortcuts for faster patient throughput
• Training a new staff member

Gregg L. Londrey, MD, a board certified vascular and general surgeon, and site Medical Director, his wife Joy, an RN, and colleague Dave all manage the vascular surgical center. The Center "offers the latest state-of-the-art equipment and non-invasive procedures to evaluate arterial, cerebral, and venous diseases." To learn more about their facility visit Vasurgical.com

Prior to Jeanette's arrival, the customer realized she needed to exchange the transducer they originally purchased for a different one and after working with Jerry and receiving the probe in 24 hours, Joy confidently said "Your company has the best customer service I have ever received....It was great to speak to a person and get immediate results." With the right equipment in hand, Jeanette's training began. Jeanette brings over 20 years of sonography experience and is a RDMS, RVT, and RPhS so putting together a customized shortcut for Joy's clinical team Amy, Dave, and Scott was second nature and very helpful for the end users. To get your copy of the Dialysis Access Fistula Exam Tips click here. Knowing there was a need to increase patient throughput she also created vascular access quick cards for the SonoSite Micromaxx and M-Turbo. Having been trained on flow volume exams, provided with shortcuts, and given knobology training for the staff, the team at Virginia Vascular Surgical Center is happy, and ready to treat patients. Another successful customer install, this time in Virginia. Stay tuned for the next stop in Jeanette's Journeys!

Clinicians who use or who are considering using ultrasound as a diagnostic tool for scanning thyroids will have a new and more effective protocol to follow when diagnosing malignant vs benign thyroid nodules. The thyroid gland is responsible for regulating our body's metabolism. The thyroid has two main hormones, which are T3 (tri-iodothyronine) and T4 (thyroxine), if the body does not release the proper level of these hormones then disease can occur.

Examples of diseases associated with an unbalanced thyroid are: Hypo or hyperthyroidism, thyroid cancer or development of solitary thyroid nodules. Using ultrasound and fine needle aspiration biopsy, radiologists from the research institute of radiological science at Yonsei University of College of Medicine in Seoul, South Korea conducted a study to categorize the thyroid nodules found on patients. Previous TIRADS have been difficult to apply in practical life so the study was devised to create a simpler categorical protocol, according to the study:

The authors used the findings to create TIRADS categories, which were defined as:

• Category 3 — no suspicious features

• Category 4a — one suspicious feature

• Category 4b — two suspicious features

• Category 4c — three or four suspicious features

• Category 5 — five suspicious features

Additionally, researchers found "several ultrasound features demonstrated a significant association with malignancy. These were: solid component, hypoechogenicity, marked hypoechogenicity, microlobulated or irregular margins, microcalcification and taller-than-wide shape."

Endocrinologists and other clinicians can apply these features in conjunction with needle visualization technology for biopsies when conducting ultrasound to assist in diagnosing thyroid malignancy.

For years patients have suffered from a variety of pain-type complaints from back pain or knee pain to carpal tunnel syndrome. Advances in medicine and portable ultrasound machines are providing relief for these patients by utilizing ultrasound for needle guided injections. For example, the AC joint at the top of the shoulder is difficult to locate due to its small size and variable anatomy. A 2006 study showed a 60% failure rate for these joint injections, Bisbinas I, et al. Accuracy of needle placement in ACJ injections. Knee Surg Sports Traumatol Arthrosc. 2006 Aug;14(8):762-5.

However, portable ultrasound machines such as the SonoSite M-Turbo or Toshiba Viamo are easy to use and feature a needle visualization software that “lights up” as the needle penetrates the skin and moves toward the area of interest. Clinicians using this technology vary from orthopedic surgeons to rheumatologists to osteopaths. Osteopathic medicine in particular is primed to embrace this technology as their practice is centered around the musculoskeletal system and joint injections have been part of patient therapy. Utilizing prolotherapy for treatment they are now able to incorporate ultrasound to capture a pre and post image of the joint, tendon or ligament, as well as improve their accuracy in joint injections.

In 2010, a group of rheumatologists conducted a study, led by Wilmer Sibbitt, Jr., M.D from University of New Mexico Health Sciences Center, which found that there was a 107% increase in patient response rate when utilizing ultrasound for needle guided injections compared to joint injections given by palpation only. In addition, “study results showed the ultrasound method led to a 14.6% (US$48) reduction in cost per participant per year and a 58.8% ($593) reduction in the cost per hospital-outpatient participant who responded to the treatment.”

Physicians describe the preferred ultrasound system to be portable, have high resolution imaging, a high frequency transducer, and be non-cumbersome since they are typically holding the probe with one hand and injecting with the other.

As ultrasound systems become smaller and the need for a quicker diagnosis becomes greater, point-of-care ultrasound has become an expanding market. The definition of this term is that those who have not been formally trained on ultrasound physics and anatomy are actually the healthcare providers now conducting the ultrasound scans for specific procedures such as vein care, needle placement, assessing organ trauma or disease.

A new challenge on the horizon is how to supply astronauts with quality imaging devices to diagnose potential medical conditions while they are on a mission in space. Portable ultrasound is one solution in providing point-of-care ultrasound to the men and women who are away from technology found on earth. Dr. Scott Dulchavsky, surgeon-in-chief at the Henry Ford Hospital in Detroit, is collaborating with the International Space Station to develop training, protocol, and recommend appropriate ultrasound equipment to provide the space teams with diagnostic capabilities.

While there are a variety of portable ultrasound systems available, SonoSite has carved out a niche in point-of-care ultrasound. These laptop-sized units weigh 10 pounds, have a lightening fast boot up time and are developed with ease-of use in mind. Training can then be centered around teaching these non-physicians to recognize anatomy and pathology, interpret the ultrasound images they are capturing and arrive at a diagnosis.

Some experts claim that the point-of-care ultrasound market takes a step backward in the field of ultrasound, so perhaps instead of an on-the- job training approach, serious consideration should be given to attending ultrasound workshops provided by specialists such as SonoSite or Advanced Health Education Center. As portable ultrasound machines are taken into space, proper training and easy to use ultrasound machines will allow our astronauts to receive quality care off the planet as well as on it.