October 2012


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Bill Johnson <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Thu, 18 Oct 2012 23:29:57 -0700
text/plain (88 lines)
Gosh darn you other Bill!

If we are so good, why do we seem so insignificant?  We are
consistantly less expensive, and so less intrusive (I admit I am a
long advocate of noninvasive technology) why are we still seen as
"second class" providers?  Why are we facing a reduction in
reimbursement for "multiple" studies?  Back in my day, I often did
arterial exams when a venous exam was ordered or venous exams when the
order was arterial but I felt the patient complaint was more related
to the exam not "ordered".  And since it was not ordered they were
done for no charge.  But now, I submit we are being restricted from
billing legitimate charges?  Of course, multiple studies have been
abused.  I think, in retrospect, I have been abused. I so resent that.

So other Bill, what can I do, what can we do to turn this around?

On 10/18/12, Bill Schroedter <[log in to unmask]> wrote:
> You are correct Joshua. But.... all the other imaging modalities also
> obtain
> 2D data - they simply construct 3D as do we. US has typically significantly
> higher resolution than does angiography, CTA, or MRA. Additionally, those
> modalities have limitations on the # of slices the use to create the image
> while we have virtually infinite #'s of slices as we scan through the area
> of interest. While our instrument generated 3D reconstruction is marginal
> at
> best (at this point in time), our mental 3D reconstruction is superb. As
> Bill Johnson notes, the key is physiology which creates a synergy with the
> imaging. We would NEVER call a stenosis based on velocity alone. But I do
> strongly agree with you, standardization and especially consistency is
> obtaining the data is critical.
> If you search back in the Flownet archives from about a year ago or so, you
> will find a post by Dr. Kirk Beach regarding reproducibility. To summarize
> his post (and correct me if I am wrong Dr Beach)
> Comparing a series of 20 Doppler vs Angiography publications, angiography
> and Doppler velocity had the following disagreement rate:
> Systolic Velocity 32%
> Diastolic velocity 33%
> ICA/CCA ratio 33% in native arteries.
> For stented arteries, disagreement was 20%, 30% and 30%.
> Comparative repeat ultrasound measurements disagreement :
> 7% on systolic velocity
> 11% on ICA/CCA ratio
> In summary -
> Ultrasound  -  7% disagreement using PSV
> Angiography - 24% disagreement between readers
> The take home, US is significantly more reproducible than is angiography.
> Bill
> William B Schroedter, BS, RVT, RPhS, FSVU
> Technical Director, Quality Vascular Imaging, Inc
> 4120 Woodmere Park Blvd
> Suite 8B
> Venice, Florida  34293
> (941) 408-8855 office
> [log in to unmask]
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Joshua Waks
> Sent: Thursday, October 18, 2012 1:02 PM
> To: [log in to unmask]
> Subject: Re: CCA criteria
> High quality duplex scanning is exceedingly important; however, there's too
> many variables and controversy.  Intra-observer variability will always
> create a difference, but if you're looking at a stenosis of >70%, where do
> you align the sample volume to?  Vessel wall or flow jet?  If it's aligned
> to the flow jet, the transducer being at a slightly different approach, the
> tech will view a slightly different jet, and get a different velocity,
> because we're viewing a 3- dimensional object in 2 dimensions.  GREATER
> I know this, and I just graduated from my Vascular Tech program!
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