Ultrasound On A Chip?

WHAT?  and how do you propose to have the images interpreted?  What Idiot would fund something like this?  Most people in medical imaging would call radiologists  very professional in looking into the human body.  They get paid to interpret images. Most of them know what they are doing.  Not all.  (giggles).  Go to any medical imaging website and know that medical imaging is a profession.
Here I will give you a partial list:  ASRT, AIUM,SDMS ARDMS just copy and paste in your browser.  People who support this person are just stupid, or have more money than I do. 

Here is a snip.  Thanks Technology Review

A scanner the size of an iPhone that you could hold up to a person’s chest and see a vivid, moving, 3-D image of what’s inside is being developed by entrepreneur Jonathan Rothberg.
Rothberg says he has raised $100 million to create a medical imaging device that’s nearly “as cheap as a stethoscope” and will “make doctors 100 times as effective.” The technology, which according to patent documents relies on a new kind of ultrasound chip, could eventually lead to new ways to destroy cancer cells with heat, or deliver information to brain cells.
Rothberg has a knack for marrying semiconductor technology to problems in biology. He started and sold two DNA-sequencing companies, 454 and Ion Torrent Systems (see “The $2 Million Genome” and “A Semiconductor DNA Sequencer”), for more than $500 million. The profits have allowed Rothberg, who showed up for an interview wearing worn chinos and a tattered sailor’s belt, to ply the ocean on a 130-foot yacht named Gene Machine and to indulge high-concept hobbies like sequencing the DNA of mathematical geniuses.

Gosh with geeks like these, we may not have use of a toilet in the future.

Gizz, with Blessings.

Obama Care Scares Diagnostic Medical Procedures

The image is from Doctor Wolfgang Morodor.

Obama care is hurting health care providers and patients.  We people in health care a trying to do our best with less resources.  I work in a small hospital now that I have retired from teaching, and our department cannot ask the ADMINS for money.  We have no money for upgrades for our imaging equipment.  How can we keep a Toshiba CT  chugging 24 hours a day without a service contract?  How can I keep my GE ultrasound machine going without some help?

Our imaging department is going to grind to dust if we cannot maintain a revenue stream.  Medical imaging is the back bone of any hospital.

Obama care is destroying health care for many reasons:  Number one is confusion.

Most Americans do NOT understand health care insurance.  It is too complex.  I agree.  co-pays etc, and Tier One Versus Tier Two.  They  sound like a Bill Cosby interview about rape.  Goorrroppsteryyerdrop.

Number two:  Health care is Expensive:

When you come to the ED, expect a hefty price.  Regardless of what your ailment is. Remember the first thing you do when you arrive in the ED with a sniffle is fork out your credit card.  Really sick people are just taken in and treated.  But the bill can cause a patients family horrible financial strife.

Number Three:  the Doctor treating you may not be a good doctor.

This is true in many settings.  There is no real good rating system for doctors. Many are slime molds festering under a gurney out to make a buck.  At your expense.  Many are great physicians willing to put a finger in your left ventricle where the bullet went, to keep you alive until the heart surgeon shows up.  ED Doctors are hard to judge, unless you work with them.  Some are morons who call CPS if you deny an expensive procedure, or drug for your child that is not necessary.   I work with one of those.  She is a terror.

Number four:  Medical imaging is expensive

Indeed.  Most hospitals rely on medical imaging to survive.  Ask the doctor why you need a CAT scan, when you fell down after you tripped on a rock.  Ask the doctor why you need an ultrasound when your gall bladder was removed 30 years ago.

Bless you all,  Here is a link for more information on how we all can better take care of our selves.

Health care reform and the shift from the fee-for-service to a value-based payment model will have a negative impact on the diagnostic imaging market in the U.S., according to a new report conducted by Decision Resources Group. Even though the elderly population is increasing and creating a greater need for diagnostic procedures, the market will only grow "modestly" through 2023.

The new payment model is transforming the radiology department from a profit center to a cost center for health care facilities, according to the report. Facilities will be taking a lot more consideration into what imaging procedures are appropriate, which means there will be a reduction in the number they perform.

Thanks Dot Med

http://www.dotmed.com/news/story/24591

Ebola, And Gil Mobley: Editorial

I know Gil Mobley.  He is a good person.  He is a great physician who does great work.  He has been in the news for donning a TYVEK suit and walking through Atlanta's Harts field airport.  I know him from some work we did together in Guatemala.  I think his comments are correct about the CDC.  His antics are a wake up call.  Gil Mobley is an intelligent doctor, and he spoke his heart.  I work in education, and patient care.  We should all wake up to his clarion call, and realize this virus takes no prisoners.  Gil Mobley was one of my students.  I taught him basic ultrasound skills in Houston Texas.  Gil, God Bless you if you see this post after the media frenzies.   TJW  Here are some links:

PHILADELPHIA (CBS) – Dom Giordano talked with Dr. Gil Mobley, who believes the CDC is lying about the threat posed by Ebola and staged a protest at Atlanta’s Hartsfield-Jackson Airport to expose it.

Thanks CBS and Dom Giorino

Credits:  
http://philadelphia.cbslocal.com/2014/10/03/missouri-doctor-its-just-a-matter-of-time-before-ebola-is-carried-to-every-corner-of-the-world/


 

Cardiologists Who Use An Ultrasound Machine To Examine A Patient?

It is Saturday.  My wife and I are sharing our twentieth wedding anniversary by going out for dinner.  I was cruising through all the doom and gloom of Ebola, and other stuff, and discovered a notable.  A cardiologist using an ultrasound machine to check on a patients heart.  When most patients come to the cardiologists come to the office, they get an ECG (EKG), and the usual vitals by the nurse.

I think that it would be great if a cardiologist TRAINED in BASIC echocardiography would use the machine to take a look at the patients heart.  A basic echo would assess cardiac output, wall motion, and other factors like valvular incompetency.  The machine to the left is not an ad.  It is one of several machines used in offices around the globe.  I think the cardiologist should use this tool in a BASIC examination of the patient in the office.  Question: reimbursement.  Oboma care?    We will see how that shakes out.  Here is a link to a useful article.

Cardiologists who used a handheld ultrasound were more likely to make an accurate diagnosis of patients with common cardiovascular abnormalities than colleagues who relied on a physical exam, for an estimated savings of $63 per patient. Handheld ultrasound’s ability to rule out abnormalities also likely would reduce downstream testing, according to a study published online Sept. 17 in the Journal of the American College of Cardiology: Cardiovascular Imaging. 

Thank you Sonoworld and Cardiovascular Business

http://www.cardiovascularbusiness.com/topics/imaging/handheld-ultrasound-trounces-physical-exams-accuracy-cost

 

Thyroid Ultrasound: Always A Great Option

I do a lot of thyroid U/S.  Many people have thyroid issues.  The go to the doctor because of malaise, or feeling tired.  Perhaps they go to the doctor for a check up and the physician feels a lump in the neck.  Many people blame obesity on a thyroid condition.  I will stay away from that.  I do believe that Fine Needle Aspiration with U/S guidance is a great tool in dealing with thyroid conditions.  Personally, if a nodule is heterogeneous, non-compressible, and icky looking, it needs a FNA.  I had a patient last week who tested positive by ultrasound.  She has follicular cancer.  She will be OK  We caught it in time I hope.  Look at the above picture and remember this is a picture of a nasty cancer.

In the retrospective review, researchers evaluated data of 465 patients with differentiated thyroid cancer (DTC) who underwent surgery at Memorial Sloan Kettering Cancer Center between January 2009 and December 2010. Fifty percent of participants underwent preoperative ultrasound of cervical neck lymph nodes, and 231 were not imaged preoperatively with ultrasound. The median follow-up was 29 months. 

 http://www.healio.com/endocrinology/thyroid/news/online/%7Bb4868556-14b2-4e31-a48a-38169b9ce1f4%7D/preoperative-neck-ultrasound-led-to-better-response-fewer-recurrences-among-dtc-patients

Surgeons View Using HF Ultrasound To Detect Lung Cancer In The Chest Wall

It seems that something new and wonderful happens everyday.  This article I will post a link to is great news on the inventiveness of medical professionals all over the world.  We in the ultrasound community have known that high frequency, high definition medical ultrasound can create great pictures, and inspire inventive solutions to medical dilemmas.  In the case of cancer, it is a wonderful area of research, and development we are doing.  Lung cancer is one of the most nasty and prevalent cancers in the world.  Enjoy reading the link.

http://www.unboundmedicine.com/medline/citation/25038014/Preoperative_Assessment_of_Chest_Wall_Invasion_in_Non_Small_Cell_Lung_Cancer_Using_Surgeon_Performed_Ultrasound_

Unbound MEDLINE

Preoperative Assessment of Chest Wall Invasion in Non-Small Cell Lung Cancer Using Surgeon-Performed Ultrasound.

Abstract

BACKGROUND
Chest wall invasion in operable lung cancer upgrades the stage and can affect operative planning. Diagnosing chest wall invasion preoperatively is important in patient consent, in the choice of operative incision placement, and can be helpful in choosing an operative approach (open vs thoracoscopic). The objectives of this study were to determine the diagnostic accuracy of preoperative, surgeon-performed ultrasound (US) in assessing tumoral chest wall invasion (T3) in non-small cell lung cancer (NSCLC) patients and to compare its accuracy vs preoperative computed tomography (CT).

OP ED Number 2

Yes, this is my second OP ED, aside from a recipe post.  I have much to celebrate.  One:  My son will be back in the USA from a missionary trip to Guatemala this afternoon (Yes he is a legal United States Resident).  They helped rebuild some community facilities in a small village there.  I will post the GO-PRO videos on my FB page. The image to the left is a picture of a volcanic lake in Guatemala called Atilan.  I went on a mission with a church 7 years ago to provide medical support there.  I taught a nurse and a physician to do limited and focused sonograms on the village people to triage them and get them to a hospital.  The living conditions are rather horrid by western standards.  The people there are chipper though, always with a grin, and a nice word.  They make do with little to nothing.  I brought an old GE ultrasound machine and taught these wonderful people how to use it for things like ectopic pregnancies, and acute abdominal pains, trauma etc.  It is not like these people here have a med-evac system.  To get to a proper hospital can take hours in a car or truck.  The trip was a great experience for me, and my son is now queuing up at the airport to come home.  This is his third journey.  My wife went on the first.  You can say we are all Guatemalan pros.  Trevor, My Son, I am PROUD.

Second:  I am working at a small hospital, and giving lectures on the side.  I cannot wait to visit the town of Kerrville, TX to present some education to the wonderful sonographers there at a specific large hospital!

 Of note: I have a student where I work.  She is doing very well with the limited education she got at a for profit fly-by-night ultrasound school in Houston.  On Wednesday of last week we had an educational meeting where I outlined what to do when she encounters a ruptured ectopic pregnancy.  Lord Have Mercy!  She was on call that very night and had a bleeder.  The abdominal cavity was filled with blood.  They did a great job and took her by air ambulance to a large hospital, and saved her life.  My sonographer student NAILED the diagnosis.  We are having a party for Logan on Monday morning.  A success like this defines both a teachers role, and a willingness of a student to learn, and act.  Logan, I am PROUD!

Sincerely, TJW

Visual Sound

Here is a great link to a visual way of understanding sound.  Sound is, in fact, a mechanical longitudinal wave of energy.

We sonographers take for granted that the transducer we place upon the patient is doing "something", but many of us do not understand the physical principles involved.  I will post a link to give us all a visual reference to what happens when a sound is created.  Enjoy.

Thanks Fluke Corp, and Nag on the Lake, and Gerard.

http://www.youtube.com/watch?v=W4s2UwKm7dc&feature=youtu.be

Fatty Liver

Contrary to most people perceptions, liver failure is due to eating the wrong stuff, and not working out.  Walking, running, and getting out to have fun  America is a sloth society. Our ancestors would wake at 4 AM, and milk the cows, and tend to strenuous activities.  They worked off the calories we people take for granted.  Many Americans get up in the morning and eat like our ancestors did, get in a car, and go to work to stare at a computer.  They take a break to smoke out side the 15 foot radius imposed by liberal nicotine Nazis.  They drink coffee from machines with jail-house coffee blends.  They buy a coke from the machine.  (1.25 US).

Many Americans eat at work.  They call out for FAST FOOD.  I am guilty.  I work my buns off, and when I am hungry I will eat any thing.  But I work.
Our kids are not mowing yards anymore.  The Illegals are doing that.  Our kids are sloths eating Capn crunch, and other crap.

We are seeing many kids with high blood pressure, and obesity because of a poor diet.  Liver failure is a horrid end to our children's lives.  Please.  Feed our kids something other than KFC. Our kids Are obese and very lazy.  This was a Public Service Announcement paid for by my 44 year old parrot.  Be well, and love your relatives.http://www.cdc.gov/healthyyouth/obesity/facts.htm

• Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
• The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
• In 2012, more than one third of children and adolescents were overweight or obese.1

Thanks CDC

A New Way To Monitor Patients With End Stage Liver Disease

This is not a subject I like to talk about.  End stage liver disease.  These patients are very ill, and not happy.  Sonographers deal with many issues but a large part of our job is the hepato-biliary system.  How many times have I been called in for a RUQ sonogram?  In many cases, the cause of discomfort is gallstones, or choleycystitis. In many cases it is liver failure.
Cholecystitis (Greek, -cholecyst, "gallbladder", combined with the suffix -itis, "inflammation") is inflammation of thegallbladder, which occurs most commonly due to obstruction of the cystic duct with gallstones (cholelithiasis). Blockage of the cystic duct with gallstones causes accumulation of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to insufficient oxygen. Not everyone who has gallstones will go on to develop cholecystitis.

http://en.wikipedia.org/wiki/Cholecystitis

Many sonographers have night mares about being called in for gall bladder attacks.  The surgeon does nothing  till 4 PM the next day. He asks the ED doctor to admit the patient. I must come out at 3 AM to evaluate a sick person with abdominal pain. Gosh I hate those late night calls when nothing is done!
  Here is something we sonographers want to look at.  Though many of us are beyond endoscopic ultrasound, it is a great read.  The link is pretty much technical, but interesting if you are into ways to look at the nasty way liver failure can take you down.  Portal hypertension is what most educated sonographers are aware of.  We can measure the diameter of the main portal vein on a sonogram.  A diameter of over 1.7 cm indicates portal pressure is elevated.  Most liver disease is caused by fatty liver disease, a subject for another post.  Here is a link to portal measurements by ultrasound.

http://www.ajronline.org/doi/pdf/10.2214/ajr.139.3.497


Now to the post. Looks like doctors can measure the restive index in esophageal varacies using ultrasound. Great.  Read the link.  TW

In patients with cirrhosis, esophageal varices are commonly observed, with an estimated prevalence of 50%[¹]. After esophageal varices have formed, the annual risk for bleeding can range from 10% to 30%[^2,3]. In patients with decompensated cirrhosis, acute esophageal variceal bleeding (EVB) represents a predominant cause for morbidity and mortality. Due to the increased risk of fatality in cirrhotic patients with EVB, the risk status in patients must be routinely evaluated such that the appropriate prophylactic therapy is administered to prevent variceal bleeding events.

http://www.wjgnet.com/1007-9327/full/v20/i22/6989.htm

Ultrasound Opens Blood Brain Barrier

The brain has been traditionally a difficult part of the body to treat disease because of a barrier that prevents, viruses, bacteria, and many medications from entering, and treating diseased parts of the brain.  This has been frustrating for ages.  Tumors, and diseases such as Alzheimer's have hidden behind this barrier since our origins.  The brain Has this "Great wall of China" as a protective measure because the neural tissue has little room for defense mechanisms within the "Keep".  This is why we have a fortified wall tho keep invaders out.  Now Ultrasound allows medicine to breach certain soncated areas of brain tissue to allow medications to enter into the brain tissue itself.  Trials are under-way to see if this is a safe and effective way of allowing medications to treat brain disease.  This is certainly a great leap in terms of treating brain lesion, and may open up other doors in many areas.  Here is an article from Sonoworld to explain the science:

KULLERVO HYNYNEN is preparing to cross neuroscience's final frontier. In July he will work with a team of doctors in the first attempt to open the blood-brain barrier in humans – the protective layer around blood vessels that shields our most precious organ against threats from the outside world.

If successful, the method would be a huge step in the treatment of pernicious brain diseases such as cancer, Parkinson's and Alzheimer's, by allowing drugs to pass into the brain.

The blood-brain barrier (BBB) keeps toxins in the bloodstream away from the brain. It consists of a tightly packed layer of endothelial cells that wrap around every blood vessel throughout the brain. It prevents viruses, bacteria and any other toxins passing into the brain, while simultaneously ushering in vital molecules such as glucose via specialised transport mechanisms.

Thanks Sonoworld and New Scientist!

Here is the link...   http://www.newscientist.com/article/mg22229742.400-human-brains-ultimate-barrier-to-open-for-first-time.html#.U6oA0ZS-3Pp

Glass? Enemy or Buddy in Health Care?

The largest internet company in the world has introduced "Glass".  Medical uses are promising.  Social uses are very worrying.  Sweet and sour.  We all know that our very existence is recorded everyday on cameras.  George Orwell was correct.  The issue is now omnipresent.  What to do with this information.  This is a national debate.  Health care is a big issue now.  We have a growing geriatric population, and returning vets who have questionable health care from the VA.  America is still the greatest place on earth to live.  However, we do not like people looking into our private lives, medical issues, or anything else.  Seems like that is big business for our current administration.  Current medical applications are promising.  I like what I see in the medical setting, as long as privacy concerns are met.  Medical professionalizes should be mindful if HIPPA, and respect a patients privacy, even with the use of devices that can send and receive images, data and other information.  Our internet is NOT secure.
The use of a device like glass is something I am uncomfortable with.  I will shun a person with the device, unless I know them.  Since I do not go to bars, or engage in any activities that are questionable, I feel that these issues will be rare.  20 cents on this one.  GG  Here is a link for you to peruse.

LEBANON, Ore.  – Waiting for a medical diagnosis could be a thing of the past.

It’s thanks to Dr. Brion Benninger of Western University of Health Sciences and Samaritan Health Services.

He’s the first in the world to use Google Glass and the Sonivate SonicEye finger probe to conduct research and teach medical students.

Paired together, Dr. Benninger can view a real-time ultrasound image in his Google Glass.

The probe slides onto your index finger, allowing you to put your hand on the patient for a physical exam.

“One of the problem with a classic probe, you have to then turn, look at the screen, hit a button and make sure it’s still the image you want.”

With the probe, there is less of a chance for error, but more importantly the doctor can maintain a patient-doctor relationship.

“When you poll patients and ask them what’s on of the most important things that you require from your physician, your doctor, your healthcare provider when you go in to the clinic, virtually all of them will say, I want them to put a hand on me and examine me.”

Dr. Benninger says it’s the human touch that patients want.

That touch can also allow the physician to better examine the patient.

Thanks KVAL. COM

http://www.kval.com/news/local/Google-Glass--259309911.html

Deviled Eggs (OP ED)

OK, you asked for it.  I stated on my FB page I would discuss a recipe for deviled eggs.  This is not an ultrasound post.

There are many people I know who make these delicious one handed morsels that we tend to hover over at holidays.  I may mention a few:  Susan: her recipe is mayo and egg yolks beaten to a pulp and put into the hardened egg whites and delivered on a disposable pan at the office.  TJ who has no idea what a deviled egg is, but he make great BBQ.  Jence, MS, and a few others who buy stuff from the HEB and are kind enough to put it on one of three tables at the office.

So here is my Deviled Egg recipe with variations.

Boil some eggs in a big pot till they are done.  About 14 minutes for a dozen eggs.  Let them sit for half an hour.  Keep them away from hungry cats.

Clear the kitchen counter.  Wash your hands.  Peal those eggs gently and separate the yolks from the firm white using a sharp small knife that allows you to divide the eggs in half.  place the half whites on a plate out of reach of the cats and toss the yolk's in a bowel.

Now the artist in you blossoms.

Lets start with a binder.  Most people use MAYO.  Hellman s or miracle whip.  You can use canola oil, or some soya milk (Yecccch).

Let's get down to the good stuff.

Beat the heck out of the egg yolks with a Maytag.  (Whisk) then add your binder.  Be gentle now.  add some cream, (YES CREAM).  just a little.  a bit of sel (Salt) and some pepper.

Here we have fun:  ADD................

sashimi

minced leftover steak

avacadoes

tomatoes

celery

onions

cumin

Cavenders spice

soy sauce

beer

left-over Doritos

clams (Cooked)

shrimp

chicken

calamari

hag fish (Cooked and de- slimed)

melon

lime and hot peppers (Stock up the bathrooms with TP!)

wasabi

fruit loops

the conversations of the senate and house.  (lightly)

some love

Fill the egg whites with the stuffing, decorate, chill, and set the platter out for people to graze.  I guarantee the platter will be empty soon!

Serve and provide multiple napkins.  Enjoy!  Thanks for you tolerance.

Gizz

Point Of Care Ultrasound Revisited

We have discussed this topic before.  I have found an article which is well written and explains the logic regarding ultrasound testing to be performed in a physicians office, or clinic at the time a patient presents with symptoms in which diagnostic ultrasound will benefit.  The time when a doctor refers a patient to a large hospital for testing is seeing dusk.  There are many great points in the article regarding the value of  diagnostic ultrasound on site.  I will let the author discuss them.  I must mention the quality of these sonograms are very much influenced upon training and experience on the part of the sonographer and interpreting physician.

In today's medical practice environment where quality, patient care, cost and profitability are critical factors for success, physicians and practice managers are looking for different ways to deliver new and existing services to enhance practice performance and offer more value to patients. While there is no one silver bullet to improve performance, medical practices are investigating the service and economic benefits of onsite imaging.  Many have chosen to adopt onsite ultrasound imaging for the advantages offered to their practices and patients.

http://www.beckershospitalreview.com/hospital-physician-relationships/the-value-of-onsite-ancillary-imaging.html

Thank You Beckar Hospital Review

Healing Bones With Ultrasound

Here is a great article, and something I have prayed for a long time.  Healing broken bones.  Let me be specific:  speeding the healing of broken bones.  In 2004 I tried something stupid.  I tried to learn along with my family the precarious art of roller blading.
I failed.  I fell and broke the surgical neck of my left humerus, and required 3 surgeries, including bone grafts from my pelvis.  Needless to say the recovery was full of the usual drooling in an arm chair watching day time TV which is why our cats and dogs go crazy when you are at work.  No wonder they like the fuzz toys we bring them home from the store to cut down on the Prozac we medicate them with.  My wife and son were great in coddling Daddy while he healed.  I had a non-union fracture though,and required surgery to harvest bone from my ischium (Part of the pelvis bone rich in hemopoetic tissues).  This required further convalescence, as you may guess, and the physician finally ordered a "TENS unit".  This awkward magnet was strapped on my shoulder for weeks and was advertised to deliver magnetic waves to heal the bone.  Though I have no scientific evidence  it did not work, it was a hassle.  Bulky and uncomfortable, I am convinced my surgeon did better work than this device.  Perhaps the article I will post a header to will show us what ultrasound will do in the next few years.  I do not condone this device, nor am I being paid to promote it because I have not used it. It looks promising.

TJW

MISSISSAUGA, Ontario--(BUSINESS WIRE)--Bioventus, a global leader in active orthopaedic healing, today announced that the next generation of its market-leading1 EXOGEN® Ultrasound Bone Healing System – including new compliance features and a healing progression Performance Guarantee – is now available in Canada.

“The release of the new EXOGEN device is exciting news for those of us who treat fractures on a regular basis. This technology has become a very useful tool for fracture treatment. The new Performance Guarantee is unprecedented and provides reassurance that Bioventus stands behind its product”

EXOGEN® – the clinically proven treatment for indicated* bone fractures – is a medical device that helps fractured bones heal.

• EXOGEN uses safe, effective low-intensity pulsed ultrasound to help stimulate the body’s natural healing process2
• It has an 86% heal rate for fractures not healing on their own3
• EXOGEN offers 38% faster healing of fresh fractures4

Thanks Sonoworld and Exogen

Medical Mistakes And Ultrasound

My apologies to all.  My family and I have recently moved to a new home.  We are living out of boxes for now, but my industrious wife and child are correcting that issue, though, I still cannot find my scrubs.  I will post this while my dog look's for my scrubs (I gave him a scrub shirt with my scent, he is a blood hound).  This issue I have today is an important one: medical mistakes.  This has haunted medical professionals ever since the practice of medicine was discovered and refined (over 2000 years).  Most lay people think medical mistakes involve wrong medications given to patients.  While that is probably true, other mistake happen.  An example is the wrong knee being replaced with a prosthetic.  Or the wrong blood is given to a patient causing holy YOU know what in the ED.  Ultrasound is becoming the standard of care in such situations like trauma to the chest and abdomen, and line placement both in the ED and in the CCU and ICU.  Insurance companies recognize this and are setting up fee schedules that encourage the use of ultrasound in many instances.  Ultrasound is becoming a wonderful tool both to eliminate errors, and insure that the patient get's the best quality of care at a "Somewhat" affordable rate.  We will yet see what the health care reform does with the wonderful tool we call diagnostic medical ultrasound.  Here is an excerpt and the link.

As a result, many leading hospitals, such as Christiana Care, are using ultrasound guidance to insert central venous lines, since the technique has been shown in several studies to greatly reduce rates of this complication—or even to prevent it entirely—compared to inserting the central catheter needle “blindly.”

Ultrasound at the bedside can also improve diagnostic accuracy and is increasingly used in ERs for the FAST (focused assessment with sonography for trauma) exam, a test to rapidly check trauma patients (such as car crash victims) for signs of internal bleeding. 

Because ultrasound imaging doesn’t expose patients to ionizing radiation, it’s now the preferred diagnostic test for appendicitis in children, as well as checking people of all ages for kidney stones, adds Dr. Sierzenski.

Thank You Lisa Colier Cool and Yahoo

http://health.yahoo.net/experts/dayinhealth/most-common-and-dangerous-medical-mistake

Smokers Now Offered Abdominal Aortic Aneurysm Screening

Sorry my friends, I have been offline for a few weeks with the flu.  Well, I am back at the helm again with some more shocking news.  Smokers are at risk of arterial disease.  Specifically, abdominal aortic aneurysms.  We have known about this for years.  Smoking does nothing good for you.  The interesting thing is that many states in the USA are making POT legal.  POT has more heart stopping ingredients than tobacco.  Well the US government is stepping out once again to limit the use of tobacco products while condoning the use of POT.  We Sonographers have long looked for triple A's in our practice.  We love to find them before they bust.  There is a CPT code for the screening.  I look for them on any routine belly exam.  Most liberals would like to to see tobacco crops destroyed, unless you are Al Gore.

Message to Sonographers?  Look for those triple A's  Here is a link to an article

The U.S. Preventive Services Task Force (USPSTF) is recommending routine one-time screening for abdominal aortic aneurysm (AAA) in men aged 65 to 75 years who have ever smoked in updated draft guidelines published online in Annals of Internal Medicine.
Clinicians should offer selective screening on a case-by-case basis for men in the same age group who have ever smoked, the draft guidelines state. If finalized, the recommendations will replace previous USPSTF guidance on the topic from 2005.e.


http://www.clinicaladvisor.com/offer-aaa-screening-to-older-male-smokers/article/331470/

Thanks Clinical Advisor

Appendicitis: Ultrasound And Multi-Modalities

I have always been an advocate of using ultrasound in the diagnosis of appendicitis.  In children, the use is a first defense.  Sure we can get lab work, and search for McBurney's sign.  I think the use of CT scanners is a burden on the patient's financial resources in a time of health care reform chaos.  We should learn to use ultrasound as a valid and very useful (and economically conservative) way to help out in acute and chronic situations.  The use of these big machines like CT and MRI are more useful in other situations.  There is nothing better than a good surgeons touch, but it is expensive at 3:00 am.  Though I will not volunteer to pull call at a hospital, or doc-in-the-box (too old and cranky), I would argue that up and coming sonographers put the scrubs on and go out to look for these lesions which are common.  I made my own DX of appendicitis 21 years ago with clinical and sonographic means.  I saved my own life with the help of a great surgeon.  He told me I was at the doorstep of death.  Yes I imaged my own appendicitis, though I do not remember.  Friends at the hospital I worked in said you were wise to come in and present as an acute patient.  They later told me I was a nasty patient.  I would hate to see a child suffer what I suffered, and not be treated correctly.  Here is an article that melds diagnostic imaging with the wonder tools a medical doctor has.  Peace TJW

FRIDAY, Jan. 3, 2014 (HealthDay News) -- A clinical pathway combining the Samuel's pediatric appendicitis score (PAS) and selective use of ultrasonography (US) has high sensitivity and specificity for diagnosing appendicitis in children, according to a study published online Dec. 30 in Pediatrics.

http://www.doctorslounge.com/index.php/news/pb/43512

Thanks Doctors Lounge

Self Directed U/S testing?

Really?  You manufacturing people want to market to people with no formal ultrasound experience?  Is the CES on LSD?  Probably.  The Consumer Electronics show is in full swing with many drunken people spilling drinks and gadgets all over Vegas.

One thing that worries me is Tom Cruise like people that have an ultrasound machine to look at the baby hour by hour in the womb.  Or worse.  Many seniors will look at the gassy upper abdomen to look for abnormalities they are not trained to look for.  They may even use one of the small machines and look at the heart and say "Mable I am Dying"  Like Redd Foxx did in an old TV series Sanford and Son's. Here is a link that makes me worried.  Happy New Year.  Look out all!

Personalization: Putting the "Me" into Medicine
More than 70 percent of respondents are receptive to using toilet sensors, prescription bottle sensors or swallowed monitors to collect ongoing and actionable personal health data. Sixty-six percent of people prefer a personalized healthcare regimen designed specifically for them based on their genetic profile or biology. And 53 percent of those surveyed said they would trust a test they personally administered as much or more than if it came from a doctor.

Though this article did not mention ultrasound specifically, I am  wary of these issues.  Perhaps I missed a sentance

Here is the full link.  Blessings all

http://newsroom.intel.com/community/intel_newsroom/blog/2013/12/09/the-world-agrees-technology-inspires-optimism-for-healthcare