Improvements in imaging machines

New ultrasound technologies make for happier physicians and patients.

By By David Geer | Spring 2013 | Tech Notes

 

In medicine, as in every market, an increasingly large, positive market impact generally translates into growing market value.

So with a forecasted global ultrasound systems market value of almost $11.2 billion by 2022, according to one report by Visiongain Ltd., it is no wonder that PracticeLink Magazine is reporting about physicians’ applications and opinions of two significant contributions among new ultrasound products.

Practical, pocket-sized Vscan ultrasound device
Price: $7,900
For more information: vscanultrasound.gehealthcare.com

The Vscan ultrasound tool fits in a lab coat pocket.

The Vscan from GE Healthcare is a mobile ultrasound visualization tool that fits neatly inside a physician’s lab coat pocket for anytime, anywhere ultrasound scanning for use in primary and emergency care, women’s health and cardiology.

Jason Jurva, M.D., a non-invasive cardiologist at the Milwaukee VA Medical Center, was looking for immediate access and views into patient heart function and structure when he found this new visualization tool.

“Of all the portable ultrasound devices, none of them are really pocket sized and travel with you all day from clinic to clinic except for the Vscan,” he says. It is the first portable ultrasound—about the size of an older generation cell phone—that offers instantaneous information, making a vast majority of diagnoses possible at a moment’s notice, Jurva explains. “At not much over a pound, it’s pretty innocuous and not too heavy to carry around all day,” he says.

And Jurva does carry the Vscan around in his daily practice, using it when rounding in the cardiology outpatient clinic at the Milwaukee VA Medical Center, for example. When Jurva is consulting with a patient and evaluating them for the first time, he can perform a quick scan of the heart, learn about the function and condition of the heart muscle, and share that information with the patient on the spot. “I can tell right away whether a patient has severe valvular disease and show it to them,” Jurva explains.

“And when seeing victims of active chest pains, I can look at the heart muscle to risk stratify them for their next treatment or early aggressive treatment.” The Vscan has utility across Jurva’s practice, running the gamut from healthy walk-in patients to critically ill people, wherever he needs to know what is going on with the patient at that precise moment.

These timesavings are especially important with critically ill patients.

“I can answer questions in one appointment in an outpatient setting, offering patients peace of mind without requiring them to make a second trip to the hospital to get their results,” he says.

Vscan features
“The Vscan’s built-in screen is larger than that of an average smart phone. The device delivers a good quality image for that screen size including color Doppler for direction and speed of blood flow across the heart valves. I can take diagnostic quality images on nearly everyone including people on ventilators,” Jurva says.

And there is no comparison between the Vscan and the typical echocardiogram when it comes to speed, availability and convenience.

When Jurva orders an echocardiogram, someone prints the order and takes the machine to where the doctor needs it, then boots it up and uses it.

“It can take one to three hours to get the results read,” Jurva says, “but the Vscan boots up in 15 seconds, enabling a point of service diagnosis in your hand. In two to three minutes, you can answer primary questions about the patient’s heart.”

Jurva’s favorite Vscan feature is the ability to demonstrate heart scan results to the house staff as well as the patient during rounding. “It enables a more intimate patient procedure because I am right there, telling them the results instead of calling them later,” he says.

As for Jurva’s wish list for future Vscan features, he is looking forward to lower pricing for his colleagues’ sakes. “Then it would be readily available to more doctors. It is fairly priced, but more than a physician can afford for daily rounds.”

Judy Mangion, M.D., applies the Vscan across research, teaching and patient care. Mangion is a cardiologist at Brigham and Women’s Hospital and was curious about the Vscan and searching for the right opportunity to acquire one when she managed to squeeze it in with a larger order. “I have since found the Vscan useful for fulfilling my patient care, teaching and research missions at this teaching hospital,” she says.

With reference to her patient care and teaching missions, Mangion uses the device as part of her rounding in inpatient cardiology with the house staff to enhance her instruction in physical diagnosis and to introduce cardiac ultrasound to residents.

Mangion has found the Vscan equally productive in outpatient care. “When outpatients return for follow up after a micro valve repair, I may not be able to justify a follow-up echocardiogram, but I can use the Vscan (to determine whether the heart murmur has increased),” she says.

Mangion further applies the Vscan to her heart failure population. “With this population, it is challenging to know what the patient’s volume status is,” says Mangion.

During a physical diagnosis, she examines the neck veins to see whether these appear distended. If so, the patient has an overloaded volume status. Mangion performs these kinds of examinations daily to determine the next form of treatment. But conclusions about volume status are difficult to make by eyesight alone if the patient is very large or thick skinned, Mangion explains. And she must make these kinds of decisions several times a day. With the Vscan, Mangion can take a closer look to be certain whether the neck veins are distended or flat and small. “I can be pretty sure of an accurate volume status assessment when using the Vscan,” she says.

The Vscan also provides evidence for patient consultations. In a case of atrial fibrillation, the patient was concerned about having what he saw as an expensive comprehensive echocardiogram. The resident who was working with that patient called Mangion, who was able to do a bedside Vscan in search of abnormalities. Finding an aortic insufficiency, Mangion was able to make a case to the patient for ordering the full echocardiogram. “Because of what I showed him, the patient agreed,” says Mangion.

When asked for her wish list of potential features for the Vscan, Mangion says, “It would be beneficial if GE could build an electronic stethoscope into it so I only need to carry the one device.” The device does occupy space in a lab coat, Mangion explains, and it can be challenging to fit it and a stethoscope in there as well. “And it would be really something,” Mangion adds, “if they could develop a 3-D Vscan to do scans in 3-D and download them to a computer for all the post processing.”

Improved Colorectal Care using the 3-D Flex Focus 400
Price: $69,900 to $89,900
For more information: bkmed.com/flex_ focus_400_en.htm

The Flex Focus 400 from BK Medical is a small, light, portable 3-D ultrasound machine with a high-resolution monitor, a fully cleansable keyboard and an optional four-hour battery.

Teresa deBeche-Adams, M.D., Colorectal Surgeon at the Center for Colon and Rectal Surgery, Florida Hospital, was looking for a 3-D ultrasound machine that could also produce better images with more detail when she found the Flex Focus 400. “We use it primarily for pelvic floor disorders and to make diagnoses pertaining to incontinence, rectal prolapse and rectal cancers in order to stage the patient properly, and to look at tumors and lymph nodes,” she says.

With pelvic floor disorders, deBeche-Adams and colleagues are able to make multiple diagnoses from one ultrasound examination using the Flex Focus 400.

“We can offer a better targeted therapy or treatment such as chemo, radiation or surgery for rectal cancers and we can taper our plans to the specific type and stage of tumor the patient has for better outcomes,” deBeche-Adams says.

Flex Focus 400 provides 3-D views.

Flex Focus 400 Features
In this unique ultrasound mechanism, a crystal takes the images while moving up and down inside a wand that the physician inserts into the rectum. “We can see inside the rectum top to bottom using 3-D images created on the device, all while the patient experiences a more comfortable exam,” says deBeche-Adams. She and her colleagues can examine tubes and surrounding tissues while looking at different slices or planes through the recreated 3-D cube visualizations of the area.

deBeche-Adams is particularly pleased with the increased level of patient comfort with the Flex Focus 400 (over a previous 2-D ultrasound machine) as well as the capacity to perform a much wider range of tests thanks to the 3-D technology. “These new images are very impressive when you see them side-by-side with old images from the previous technology. They are much better quality,” says deBeche-Adams.

As smaller, more evolved ultrasound machines advance the technology revolution, their investigative precision should insinuate itself into more planes of examination, closing the gap between near-immediate, exhaustive and accurate diagnoses and targeted rather than explorative treatments.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.

 

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