Bill Johnson, Dunmore, PA
***WARNING*** Long rant here. Not for the faint of heart.
I do not mean to be agist, but I think you might have been performing good
studies before Duplex, for goodness sake, I have known you for a long time.
I also know of your efforts in other countries to make good diagnostic
studies available under difficult conditions. (You have my greatest respect
An OPG in the right hands is an excellent diagnostic tool, although Bart
might have some real trouble getting folks to try them in drugstores for a
quarter. I remember Dr. J. Yao once complaining to Dr. W. Gee about the
prospect of getting his eyeballs sucked.
The CPA (carotid phonoangiogram) was, in my opinion, a great overlooked
resource in noninvasive screening. Simply a microphone connected to an
oscilloscope used to document cervical bruits. And, I believe, in the right
hands, it could differentiate an external from an internal carotid stenosis.
I know a lot of good technologists (well, mostly older folks, granted) that
can identify a significant stenosis with a handheld CW Doppler. Every piece
of equipment we have, used to have, or can imagine having, is operator
dependent. I do not expect that to change anytime soon.
Because someone is in a Radiology lab, a screening company or an accredited
lab does not make them good or bad. What they do and how they do it makes
them good or bad. Training usually enhances ability, not always.
Credentials, as we know them, do not document ability, only entry level
knowledge. There is no skill assessment in any credential to date to my
Accreditation does not assure competency. It does assure that certain
standards are maintained in education, qualifications, quality assurance, and
operations. Competency cannot be assumed, but competency is much more likely
in an accredited facility. The issue is how you work, not for whom you work,
or even what equipment you use.
That said, could we not find a way to resurrect that uncomplicated and
inexpensive device, the CPA, generate a computer bruit recognition program
that could identify holosystolic cervical bruits and provide a print out to
take to your physician? Get a sponsor, put these in the drugstores next to
the BP machines and effectively, efficiently, and economically replace the
entire issue of carotid screening?
Think of it. Sit down at the machine, put a microphone on your neck, hold
your breath (not to hard for most of us still) drop in a quarter, and find
out your potential risk of carotid disease?
Oh, we would miss the occlusions and string signs, but I am afraid present
screenings miss these also. And some radiated bruits would be picked up, not
a bad thing either...
Next to our CPA machine, we find a way to adapt the automajik BP machines to
have four cuffs and perform ABIs to screen for PVD. Maybe charge a buck and
a half for this one. Get a drug sponsor? Positive studies dispense a free
sample of _____ aspirin (brand name deleted) and a card telling you how to
make an appointment with your local cardiologist group, (positive ABI's are a
significant marker for cardiac disease, you know) as well as your local
vascular lab (with the appropriate referral, of course. We would also pick
up possible subclavian steals.
I know I often write in a less than serious vein (vane?) and it is usually
dangerous to take my comments too seriously. But I am much more serious here
than my prose would suggest. We, my friends, have the knowledge to do
something that could significantly contribute to the health and well-being of
people, beyond what we routinely do.
Is this nonsense?