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I agree with you. Start simple and answer questions as they arrise. More
importantly - and something I try to drill into the head of
students/residents - apply the "So What?" factor. You want a test result and
you get it, SO WHAT? What are you prepared to do with the result? If
intervention isn't planned why the detailed study? Imaging tests primarily
document anatomy, ABI's document physiology. If the question is "why do my
patient's legs ache when he/she walks 200 yards", then knowing that there's
a focal step up in velocities in the SFA's isn't going to get you any
further than an abnormal ABI. Smoking cessation, exercise, diet and other
life style modifications will be urged, medicines prescribed and follow ups
scheduled in the vast majority of patients by vascular surgeons armed with
physiological data and a good history and physical. If the patient is going
to have any kind of intervention then angiography will be used (still the
Gold standard anatomical test) rendering the duplex study redundant. Of
course there are exceptions to everything (the standard CYA statement).
 Keep this in mind:
 Duplex studies reimburse at a higher rate than physiologic studies.
The majority of radiology departments are devoid of physiologyic testing
equipment.
Radiologic interpretations tend to be wordy. A duplex exam uses lots of
words and numbers to dicatate.
 The irony is that plethysmography is easier to train, more reproducible,
less expensive to acquire faster (or as fast) to perform and easier to
interpret than duplex studies. Unfortunately, the field of vascular testing
is becoming "technocentric" in favor of imaging over physiology. Even the
title of the role has changed from technologist to sonographer.
 Steve
(have stick, will poke)

 On 10/18/05, Dianne Gruber <[log in to unmask]> wrote:
>
> Back to poking sticks (doing imaging as the primary test, and ABI's "if
> needed"). Having just had a dialogue with a radiologist on this subject, I
> would be interested to hear it addressed (ok, again). My position was
> physiologic first, imaging if needed for clarification (this is the
> protocol we observe here). His was imaging first, abi's if imaging shows
> disease. Viewpoints?
>
> Dianne Gruber RVT RDMS
> Maryville, TN
>
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