As always with this issue, I have to come down on the side of Dinah and Bart
Bean. Screening, for any type of occult pathology, is never meant to replace
the full compliment of diagnsotic testing typically associated with finding
and assessing disease. The role of screening is to detect those individuals
at higher risk of significant underlying pathology so they can be referred
for more sophisticated and complete workup. PSA and CA 125 surface antigens
are tumor markers that MAY be elevated in the presence of cancer, they may
also be negative or elevated in the presence of benign pathology. Maternal
serum AFP is a screen for neural tube and other fetal defects. An elevation
raises the concern that such an anomaly might exist, but elevated AFP may
also be found (and usually is) in pregancies that are quite normal.
Screening for carotid disease, PVD or AAA falls into the same category.
While I am, and have always been, a strong supporter of ARDMS credentialling
in all specialty areas in which a person performs professionally, I would
argue that in many instances, the person doing "screening" studies does not
have to measure up to the same standards that a "pro" in a vascular lab does.
The job of the screener is to be vigilant to possible abnormal findings and
then counsel the patient to seek follow up care from his/her primary care
provider and/or specialists. It is incubent upon the lab to which the
patient is referred to make the proper and final diagnosis. And before we in
dedicated vascular labs get too haughty, let's not forget the 20/20 or
Lifeline segment aired a few years ago in which a patient with a known
subclavian steal was sent to 9 vascular labs in Florida, some of which were
ICAVL accredited and presumably RVTs did or "supervised" the exams. NO LAB
found the steal. I agree with Dinah that it is unfair, and I think it a bit
arrogant, to issue blanket condemnations of services that may help prevent
debilitating disease based on anecdotal data or the fact that some of the
personnel used by screening comapnies are not RVT or RVS.
My own anecdotal experience with Life Line overall has been positive. They
have come through the SF BayArea several times over the past few years and I
have done f/u studies on about 20 patients. While I may use slightly
different grading criteria (especially for carotids) the screening results
and I were always in the same ballpark. And I would much rather have a
patient be referred to for f/u testing even if it turms out to be normal than
I would see that patient end up a comatose or paraplegic vegetable.
One final comment. Based on the marketing information copied to this
listserve by other participants, I cannot take issue with most of the
information provided. Without going to the literature to back up the
statistics, overall they are in agreement with what I tell a lot of my own
Jim Baun, BS, RDMS, RVT, FSDMS