Echocardiograms Not Interpreted

With all that is going on in health care, now we have something new to worry about.  

"Nearly 4,000 tests for heart disease performed over the last three years at Harlem Hospital Center — more than half of all such tests performed — were never read by doctors charged with making a diagnosis, hospital officials acknowledged Tuesday." 

People assume medical testing is scrutinized rigorously by Doctors interested in only the highest quality medical testing and treatment.  The public assumes that when they talk to their Doctor about a medical test or procedure, the discussion is based upon rigid quality assurance.  For example; if the Doctor calls a patient to tell them their mammogram is normal, most people assume they have nothing more to worry about.  This article regarding echocardiograms that were never reviewed by a physician is a clarion reminder that patients must always be involved in their medical care.  As an echocardiographer, it pains me to read it knowing that serious diseases or conditions could have gone unreported.  We echocardiographers are charged with obtaining diagnostic information and images to be reviewed by a qualified physician so a medical diagnosis can be made.  An echocardiographer does not generate a final report, or a medical diagnosis from the images obtained from an echocardiogram.  Many institutions require the echocardiographer to generate a preliminary report, but that is not the same as a physician reviewed final report. Most of my colleagues will cringe when they read this piece.

"While the process the doctors followed may have alerted cardiologists to those echocardiograms that were most likely to be abnormal, the failure to read the echocardiograms in a timely manner is inexcusable and may have placed patients at risk,” Alan D. Aviles, hospitals corporation president, said in the statement." 

Read the full article here.   
http://www.nytimes.com/2010/05/26/nyregion/26hospital.html

New Trials Attempt To Bring Ultrasound Contrast to America (Again)

As many of you know, I am a big fan of contrast enhanced ultrasound (CEUS).  The United States FDA has limited its use to echocardiography. CEUS has been used safely for many other procedures in other countries for several years.  There are several issues at play as to why the USA is lagging behind other countries in this area of diagnostic ultrasound.  I won't go into them all except to say that a few years ago CEUS got a bad rap here for being falsely implicated in some patient deaths.  A new endeavor is currently in the works to establish some trials in America with the goal of identifying safe, and effective means of providing useful information in other goal-directed studies including identification of some liver and kidney masses to name but a couple.  Europe has been using CEUS for some time now to differentiate liver masses in terms of cancerous versus benign hyper-plastic lesions, and with great results.  I think it is time we set politics aside, and do some good research that may allow us Americans access to affordable, and safe alternatives to other expensive diagnostic solutions such as CT and MRI.  Here is a link to an article I saw on Aunt Minnie this morning. 

ATLANTIC CITY, NJ - The lack of approval of radiology ultrasound contrast in the U.S. has long stuck in the craw of the technology's advocates. But clinical trials are now moving forward with hopes of rectifying the situation, according to a presentation at the annual Leading Edge in Diagnostic Ultrasound conference.   http://www.auntminnie.com/index.asp?Sec=sup&Sub=ult&Pag=dis&ItemId=90583&wf=3735

Ultrasound As A Long-Term, Reversible Contraceptive

A recent article announced the awarding of several grants by the Gates foundation for "Grand Challenge Exploration".  One of the grants research centers on male contraception using ultrasound thermal destruction of sperm. 

CHAPEL HILL — The University of North Carolina at Chapel Hill has received a $100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation.  The grant will support an innovative global health research project conducted by James Tsuruta, PhD, and Paul Dayton, PhD, titled “Ultrasound as a long-term, reversible contraceptive.”

“Our long-term goal is to use ultrasound from therapeutic instruments that are commonly found in sports medicine or physical therapy clinics as an inexpensive, long-term, reversible male contraceptive suitable for use in developing to first world countries,” said Tsuruta."  What about the long term risk of cancer or other diseases?  And what about the effects on the remaining germ cells?  Is the DNA affected?  Are they talking about therapeutic ultrasound machines used to treat muscle pain? Is the procedure painful?  I will keep my eye on this hot topic. 

http://www.med.unc.edu/www/news/unc-researchers-receive-100-000-grand-challenges-exploration-grant-to-develop-male-contraceptive

Canada To Charge For Gender Identification

Some hospitals in Canada will soon charge pregnant patients to identify the sex of the fetus.  A fee of 50 Canadian dollars will be charged if the sex of the baby can be determined.  If the sex cant be determined, the fee will be refunded.  It is interesting to note that the sex will not be mentioned by the Sonographer, but will be part of the official Radiologists report to be sent to the patient's physician.  The sex of the baby will only be revealed after the patient completes her 20th week of pregnancy.  This is done primarily to thwart abortions by patients unhappy with the sex of the fetus.  In India and China, many female babies are aborted because of social stigma associated with having females.

"The College of Physicians and Surgeons is against fetal gender determination for non-medical purposes on the grounds that they may violate the principle of equity between males and females and may set a precedent for "eugenic decisions that are socially repugnant."

Read more: http://www.vancouversun.com/health/Bring+credit+card+pregnancy+ultrasounds+want+know+girl/3011258/story.html#ixzz0oOBIb2vx

Thyroid Biopsy With Ultrasound

When performing fine needle aspiration (FNA) of the thyroid under ultrasound guidance, it is difficult for the physician to know if the specimens are adequate to diagnose the characteristics of a nodule without guidance from a pathologist.  Specimens must be fixed immediately, and correctly for the diagnosis to be made.  I found an article addressing ways to limit the number of failed biopsy's, thus limiting the need to call a patient to come back in for a repeat procedure.

Requests for ultrasound-guided biopsies for the diagnosis of thyroid nodules have increased rapidly in recent years, putting a strain on radiology departments everywhere," said Wui K. Chong, MD, lead author of the study. Unfortunately, there are a number of inadequate biopsies (where the pathologist deems there is an insufficient amount of information to make a diagnosis) that ultimately must be repeated.

http://www.physorg.com/news192269487.html