I have just read the rantings of several people defending or bashing Lifeline
Screening. Dinah made a plea for people to check out their service. I think
that is a great suggestion. Without first hand knowledge of their product it
is difficult to criticize.
With that being said, in April, I took a friend with known disease to one of
Lifeline's screenings armed with a tape recorder. I scanned the patient with
another RVT one hour prior to the exam. When we entered the hall where it was
being done, the three gentleman who were performing the studies were arguing
about the proper way to calculate an ABI (the one with the least experience
had it right). The room had one privacy screen in the Aorta area.
The carotid was performed first on an ATL Ultramark 4. No color if you're
into that kind of thing. I timed the bilateral test. 2:43 minutes. The sample
volume was placed 1 cm distal to the area of plaque and a picture taken.
Brochure states state of the art equipment.
Aorta next on an old portable Aloka (no color, no Doppler). Aortic
measurement taken through gas (BTW this was the guy with the least experience
who was right about the ABI). 1:54 minutes.
ABIs were taken next over the patient's sweatshirt. Reported as normal by the
person taking the pressures. 3:49 minutes.
No histories, no physical exam. Patient volunteered some info that was never
written down (i.e., history amaurosis, iliac stents). They seemed to have no
clue what the patient was talking about.
My conversation with the head guy baffled me. I read off of their brochure
about registered or registry eligible. When I asked what registered meant he
said that you have to take a test. I asked if he took the test and he said
yes. When asked if he or the others passed the test, he said that not
everyone passes the first time. What does that mean?
As we were leaving, we were told by the head tech that all of the studies
were normal and that the results would be mailed from a "qualified" vascular
surgeon. When I asked about their positive studies, I was told that usually
one test a day out of an average of 60 patients (about 150 tests a day per
the tech) had disease (<1%).
The results came back. ABIs reported normal; actual ABI right .93, left .88.
BTW, patient had elevated velocities through stents. Aortic dimensions were
several mm different from our measurements; not too bad. Carotid reported as
normal with no mention of plaque; on our study, slightly elevated velocities
THROUGH the plaque.
Is screening of asymptomatic patients beneficial to our general population? I
think that it might be. That is why Dr. Lavenson and SVT are doing the
CARFUSS study. Is screening asymptomatic patients by unqualified personnel
employed by a for profit company without a clear cut QA program of benefit? I
don't think so. How can a company without a professional relationship with
the physicians in the area, follow-up for accuracy? By surveying the
patients? What if the patient never followed up because they were told they
were normal? What if the patient had a stroke because of a missed stenosis,
dissection, thrombus? Have accredited labs and personnel missed significant
findings? Of course but they have at least shown some kind of minimal
competency to perform these tests. Dinah, until you prove to many people out
there that your service benefits the community, many people will discourage
the use of this type of service.
If there are questions about my comments feel free to contact me directly so
that we don't clog the Flownet.
Joseph P. Hughes RVT RVS
Phoenix Cardiovascular, Inc.
875 N. Easton Road
Doylestown, PA 18901