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Special report: Ultrasound

by Carol Ko, Staff Writer | July 05, 2013
International Day of Radiology 2012
From the July 2013 issue of HealthCare Business News magazine

In the future, the technology may also help improve the way doctors perform liver studies, which are currently blind to liver stiffness. “They go in with a needle hit a zone, take a sample and come back out and they might have missed the stiffest region in the liver,” says Michele Debain, global marketing director of SuperSonic. Using elastography, doctors can map the entire liver to classify disease without requiring the patient to undergo unnecessary biopsies.

Though SuperSonic started off in breast imaging in 2009, they now seek to expand the product’s application to other areas such as thyroid nodules or prostate cancer.However, being relatively new to the market, elastography lacks robust market data and is also not currently reimbursed — an obstacle to wider adoption.

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Though the technology holds a lot of promise, it may not quite stack up against the gold standards in prostate, breast or thyroid imaging — at least not yet.“They need to spend more time on the studies and prove its clinical efficacy,” says Esaote’s Parhar.

Turf wars
It’s not all sunshine for ultrasound. As the technology’s reach expands to various specialties, there’s been some pushback.

For instance, an article published in the Journal of American College of Radiology observed that the use of musculoskeletal ultrasound among non-radiologists has exploded in the last decade. Podiatrists performed 76,332 ultrasound studies in 2009, up from just 3,920 in 2000 — a staggering 18-fold increase.

In response, some insurance providers have expressed concern that the ready availability and low cost of ultrasound is probably increasing the instances of unnecessary ultrasound screenings. Some radiologists point out that non-radiologists who have their own equipment have a strong financial incentive to self-refer screenings, creating an inherent conflict of interest.

To be fair, there are also some possible benefits to such an arrangement: being able to screen and clinically evaluate patients in just one visit, in real time, may actually improve throughput, increase patient satisfaction and reduce the necessity of more expensive MRI scans.

Meanwhile, radiologists continue to debate whether compact ultrasound systems, which now make up nearly half of ultrasound equipment unit sales in the U.S, pose a threat to existing imaging technologies. Compact ultrasound systems in particular are attractive to non-radiologists because they’re inexpensive and relatively easy to use.

Naturally, ultrasound proponents like to think so. “I really believe compact ultrasound is under pressure to remain the sole domain of radiologists. There are a lot of forces that are trying to keep the status quo,” says Parhar. He predicts that as emergency physicians and physicians from other specialties such as OBGYN and cardiology continue to adopt ultrasound, radiologists will gradually relinquish expertise over that technology.

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