Hi All: I'd like to add my two cents worth here...a long, VERY long time
ago, I wrote a paper in the "Bruit", when the field and the journal were
both new. I was able to connect with Bart Bean, who was President of the
SVT, (back then), and with his help, and a lot of brain searching, I applied
the ear clips portion of the OPG in a different manner, which at the time
was quite exciting. I was able to purchase flat sensors which connected
around the wrists with Velcro. I applied these over the palpated radial
arteries, after taking and recording bilateral brachial blood pressures, and
recorded the pulses from the radial arteries, and looked for delays in
upstrokes from side to side. The paper was written to describe this
procedure, and its possible use in detecting subclavian or brachial artery
stenosis. I was also taught to auscultate for bruits by the Vascular
Surgeon I worked with, and recorded the presence or absence of cervical, or
supraclavicular bruits, then backed this information up with the CPA. These
tools were so valuable at the time, and I can see their possible comeback in
the so called "screening" labs that seem to be popping up everywhere. Of
course, all the old issues come up here, again...training, experience, etc.
My point is this: I've always believed in the "old ways", and have always
believed that if the "old ways" are not forgotten, they will remain ever
valuable. I think the screening labs are going to be around for awhile, and
I always hope, fervently, that whoever goes through one of these
"screenings" will follow up with their own physicians, who might just take
the time to perform a few simple tasks him/herself. The "old ways", like
palpating pulses, auscultating for bruits, asking vascular-disease
appropriate questions, etc.
In Hope, Always,
Shirley McLean, RVT
San Marcos, CA
----- Original Message -----
From: Bill Johnson <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, August 26, 2000 3:42 PM
Subject: Re: Screening, the UM4, OPG, CPA and everything
> 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
> I also know of your efforts in other countries to make good diagnostic
> studies available under difficult conditions. (You have my greatest
> in this.)
> 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
> hands, it could differentiate an external from an internal carotid
> I know a lot of good technologists (well, mostly older folks, granted)
> can identify a significant stenosis with a handheld CW Doppler. Every
> 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
> 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,
> operations. Competency cannot be assumed, but competency is much more
> in an accredited facility. The issue is how you work, not for whom you wo
> 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
> take to your physician? Get a sponsor, put these in the drugstores next
> 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,
> a bad thing either...
> Next to our CPA machine, we find a way to adapt the automajik BP machines
> have four cuffs and perform ABIs to screen for PVD. Maybe charge a buck
> a half for this one. Get a drug sponsor? Positive studies dispense a
> sample of _____ aspirin (brand name deleted) and a card telling you how to
> make an appointment with your local cardiologist group, (positive ABI's
> significant marker for cardiac disease, you know) as well as your local
> vascular lab (with the appropriate referral, of course. We would also
> 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
> than my prose would suggest. We, my friends, have the knowledge to do
> something that could significantly contribute to the health and well-being
> people, beyond what we routinely do.
> Is this nonsense?