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UVMFLOWNET  September 2007

UVMFLOWNET September 2007

Subject:

Re: DIAMETER REDUCTION MEASUREMENTS

From:

SUBSCRIBE UVMFLOWNET robert rosner <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Sat, 8 Sep 2007 10:23:47 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (130 lines)

Jason, may I ask what part of the country are you practicing in? Just curious. 

If one imagines a longitudinal image of a vessel (based on trans. view for 
correct sagittal angulation and true representation) and an 80% reduction is 
observed, unless you get a number of good transverse views to corroborate, 
the vessel in actuality COULD between 40% and 80% stenosed. I wish I could 
post a quickie drawing! :(  

The shape of the plaque and just how this plaque occupies this space is key. 
As we know, plaque formations can be a bit creative in shape, not to mention 
the sneaky, stealthy and DANGEROUS markedly hypoechoic "time-bombs" I 
have seen on patients that are no longer with us. :( 

Docs like their CT and MRI's. Combination of financial interests (look at the 
reimbursement rates) and the fact that there is little decisional latitude from 
the technology aspect involved in the performance, quality and presentation 
of these images as opposed to Sonography. They like the consistency they 
achieve with the$e other modalitie$. (Sorry, #4 ands shift key stuck..lol). 

This attitude, other than financial considerations, could very well boil down to 
the ever increasing number of poorly trained, poorly practicing Sonographers 
out there for whom nailing EVERY study to the "wall of truth and accuracy" 
means little to them (they never admit this), nor do they have ANY curiosity 
regarding outcomes of subsequent imaging studies. Lazy paycheck grabbers 
make Radiologists distrustful. I see it as an epidemic the past 10-20 years. 
Sociopaths, perhaps? Many to blame for this. 

Bottom line Jason, The docs are the boss, but by being inquisitive in a 
scientific, respectful, and even suggestive way, THEY will do things as they 
see fit unless there is good feedback from the doods on the front lines (that 
be us).

PS:

Note: I had a vision yesterday. For those in my imaging facility that really 
have no idea what Sonographers do and are responsible for, versus CT and 
MRI Technologist's .....

I was going to demonstrate....


 ......A patient in my room...positioned on my table supine and ready to go. 
Little Taj Mahal pile of gel on the RUQ. Take the probe and place probe on gel 
pile and stand back away from probe and patient. Let's see what that machine 
can do, baby! :D  This ain't' no automatic meat slicing machine, is it????  Nuff' 
said, fo' sho'. 



RR

---------------------------------------------------------------------------
On Sat, 8 Sep 7 04:54:04 -0700, JASON ROBERTS <[log in to unmask]> 
wrote:

>
>I have to agree with you, but there are plenty of radiologist out there that 
trully believe that 
>2-D imaging is the same as a CT or MRI, which I might add is some what 
questionable at times. However, there are plenty radiologist around my area 
that still demand long axis measures, but I think it is mostly because this 
method of measurement is under constantly scrutiny by the vascular 
department. It becomes a tit for tat type argument
> 
>Jason > Date: Fri, 7 Sep 2007 23:16:19 -0400> From: 
[log in to unmask]> Subject: Re: DIAMETER REDUCTION MEASUREMENTS> 
To: [log in to unmask]> > On Fri, 7 Sep 2007 13:10:35 -0400, 
Macclellan <NJMacclellan@COLLINS-> CC.K12.OH.US> wrote:> > >I HAVE JUST 
STARTED FILLING IN FOR A VASCULAR SURGEON PERFORMING > VASCULAR 
SONOGRAPHY. HE IS REQUESTING DIAMETER REDUCTION > CALCULATIONS 
THROUGHOUT THE EXTRACEREBRAL VASCULAR EXAMINATION. > I HAVE AN 
OPINION, HOWEVER, I WOULD LIKE TO KNOW IF ANYONE IS > PERFORMING 
THIS ROUTINELY, ARE YOU PERFOMING THIS CALCULATION IN > LONG OR 
TRANS. THANKS FOR ALL RESPONSES.> >NANCYMAC> >Nancy MacClellan BA, 
RDMS, RVT> >Program Director, DMS> >Collins Career Center> >740-867-
6641, extension 526> >[log in to unmask]> >> >To 
unsubscribe or search other topics on UVM Flownet link to:> 
>http://list.uvm.edu/archives/uvmflownet.html> > > Nancy, > > Forget the 
longitudinal part! That is way too much to think that any > sonographer with 
any spacial relationship skills would EVER depend on, let > alone a fairly 
intelligent surgical group! Yikes!> > What possibly could the physician's 
rationale be for attempting to determine %> stenosis calculations via diameter 
reduction measurements when this is so > blasted outdated? (Dr. Strandness, 
RIP and hang in there friend. No need to > roll over) :O) > > So many vessels 
are often calcified in this target population age, and even > with rotational, 
window-searching scanning approach, valsalva to distend the > jugular window 
techniques..... calcification's often "beat" ultrasound regarding > penetrability. 
Give me a soft plaque anytime, and I'll build you a case. MRA's > often end up 
kissing my butt come post-angio and post-surg because they > can and do 
mislead Radiologists. We can do better with ultrasound! Remember > folks, we 
are examining a fairly simple tube with fluid dynamics. Velocities RULE > for % 
stenosis in the mod to critical range.> > In 3 decades of scanning, I have 
noted many times velocities are WNL, but > there is a nasty, irregular or 
smooth annular plaque that can appear to > stenose an ICA bulb by 60% on 
transverse views. Sure, the complex > hemodynamics in the bulb get modified 
and streamlined, but still less than > twice a distal CCA velocity measurement, 
right? > > THINKING::::Gee, do ya think the rest of the arterial system has the 
same > atherosclerotic burden? Is that more important than silly calcifications 
with > minimal diameter reductions? NAH!!::::> > Longitudinal views for % 
stenosis? Lawdy, tell me these guys are NOT serious!!> > Other than plaque 
pathology and Intima-media thickness, VELOCITIES and > ratios, judiciouisly 
appled, are the only way to go to accurately gauge a > stenosis, using color 
doppler as your guide with the correct PRF threshold > initially to 
broadly "check out the whole tube", and then to be used to find max > jet 
velocities by increasing the PRF till the location of max velocity is revealed.> > 
If one has not spent following up NIC exams and correlating them with > 
subsequent angiograms, MRA's, digi-subtr, or whatever, (are you out there?) > 
then Mr./Mrs. Sonographer will never learn from his/her mistakes or judgement 
> errors. Nor do many WANT to learn. They know it all, you know. :O/> > And 
did I mention it's a marvelous idea to keep your insonation angle at 60% > 
ALWAYS, and heel/toe and use colorbox/insonation angle changes to your > 
advantage. Consistancy, scanning acuity and agressiveness RULES and will > 
make you a prized sniper for your docs, and ultimately the patients you help > 
them to initially diagnose.> > "I WOULD LIKE TO KNOW IF ANYONE IS 
PERFORMING THIS ROUTINELY, ARE > YOU PERFOMING THIS CALCULATION IN 
LONG OR TRANS. THANKS FOR ALL > RESPONSES"> > No, and neither. I wish 
you the best of luck and let us know what in god's > name these docs want 
with the technology we have at hand here, ok Nancy?> > RR> > To 
unsubscribe or search other topics on UVM Flownet link to:> 
http://list.uvm.edu/archives/uvmflownet.html
>_________________________________________________________________
>Capture your memories in an online journal!
>http://www.reallivemoms.com?ocid=TXT_TAGHM&loc=us
>To unsubscribe or search other topics on UVM Flownet link to:
>http://list.uvm.edu/archives/uvmflownet.html
>

To unsubscribe or search other topics on UVM Flownet link to:
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