the role of musculoskeletal ultrasound in occupational ... · musculoskeletal ultrasound in...
TRANSCRIPT
The Role of Musculoskeletal Ultrasound in
Occupational Medicine
T. Greg McKelvey Jr. MD, MPH
PGY 3
Occupational & Environmental Medicine
University of Washington
Diagnostic, Point of Care
“Prediction is difficult,
especially about the
future.”
“You have to know the past to
understand the present”
1964
Anisotropy /ˌænaɪˈsɒtrəpi/ is the property of
being directionally dependent, which implies
different properties in different directions, as
opposed to isotropy.
We have identified strong out-of-band emission at 2.3–2.5 GHz associated with several peryton events.
Subsequent tests revealed that a peryton can be generated at 1.4 GHz
when a microwave oven door is opened prematurely and the telescope is at an appropriate relative angle
2015
“No pleasure is
comparable to the
standing upon the
vantage-ground of
truth.”
1712
d. 1626 1776
1016 1916
1816
“It is not from the benevolence of the
butcher, the brewer, or the baker that
we expect our dinner, but from their
regard to their own interest.”
~1439
1793
1916 2006
“One of the essential qualities of the
clinician is interest in humanity, for the
secret of the care of the patient is in caring
for the patient”
1965
1947
1945
1941
1953 1959
“I suppose it is tempting, if the only tool you
have is a hammer, to treat everything as if it
were a nail.”
1984
1996
1998
2001
1927
1918 1940
1958
“A major hurdle in brain-machine interfaces (BMI) is the lack of an implantable neural
interface system that remains viable for a lifetime.”
Non-ionizing, low-cost, on-demand, dynamic, point-and-shoot, instant resulting, handy dandy imaging modality
But wait, there’s more...
...evidence-based...
“Interestingly, one finding of this
study is that, when performed
by specially trained operators,
shoulder US may not be
as user dependent as previously
thought since, for the diagnosis
of a full-thickness RC tear,
diagnosis was similar whether
trained radiologists, sonographers
or orthopaedists performed
the US examination.“
“The substitution of MSK US for MSK MRI, when appropriate, would lead to savings of more than $6.9 billion in
the period from 2006 to 2020.”
...fiscally-responsible..
“Our cost-savings projections assume that US can replace MRI, not that both tests will be performed in a
single patient, which might increase costs.”
“The substitution of MSK US for MSK MRI, when appropriate, would lead to savings of more than $6.9 billion in
the period from 2006 to 2020.”
However, it is important to take into consideration
that the sonographers and orthopaedists who performed
the US examination in the included articles were
specially trained, and that there is a steep learning curve to
US.14
“Therefore, the use of ultrasound at the point of care must
be linked to specific training that should be defined in curriculum
such as the one recently updated by the American Medical
Society for Sports Medicine (AMSSM).”
Non-ionizing, low-cost, on-demand, dynamic, point-and-shoot, instant resulting, handy dandy imaging modality
“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination.
Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet.
Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?”
“He wanted to show that fate ruled people's lives, and that those who interfered with it did so to their sorrow”
“A recent policy change at Blue Cross
Blue Shield (BCBS) for Texas, Illinois,
New Mexico, and Oklahoma
regarding musculoskeletal (MSK) ultrasound
illustrates how the status
of reimbursement for diagnostic
imaging can change overnight.”
1. Sayeed Y, Sully K, Allen A, Werntz CL. The emerging role of musculoskeletal ultrasound in occupational medicine. J Occup Environ Med. 2014;56(12):e160.2. Sayeed Y, Allen A, Minardi J, Kurdi H, Werntz CL. Musculoskeletal ultrasound in American Occupational Medicine Residency Programs: a survey of program directors. J Occup Environ
Med. 2015;57(5):e55-6.3. Sayeed Y, Marrocco A, Sully K, Werntz C, Allen A, Minardi J. Feasibility and Implementation of Musculoskeletal Ultrasound Training in Occupational Medicine Residency Education. J
Occup Environ Med. 2015;57(12):1347-52.4. Sully K, Schaefer M, Allen A, Werntz CL, Ma G, Sayeed Y. Musculoskeletal Ultrasound Use Among Occupational Medicine Practitioners at the American Occupational Health
Conference. J Occup Environ Med. 2016;58(8):e315-7.5. Kane D, Grassi W, Sturrock R, Balint PV. A brief history of musculoskeletal ultrasound: 'From bats and ships to babies and hips'. Rheumatology (Oxford). 2004;43(7):931-3.6. Jacobson JA. Shoulder US: anatomy, technique, and scanning pitfalls. Radiology. 2011;260(1):6-16.7. Amoo-achampong K, Nwachukwu BU, Mccormick F. An orthopedist's guide to shoulder ultrasound: a systematic review of examination protocols. Phys Sportsmed. 2016;:1-10.8. Seo D, Neely RM, Shen K, et al. Wireless Recording in the Peripheral Nervous System with Ultrasonic Neural Dust. Neuron. 2016;91(3):529-39.9. Mariani PJ. Ultrasound use and "overuse". West J Emerg Med. 2010;11(4):319-21.10. Missing sisters- A shortage of girls will haunt India for decades11. https://www.sonosite.com/sales/reimbursement12. Radiologists Must Play Central Role in Point-of-Care Ultrasound Training13. Handheld ultrasound: Threat or opportunity?14. Adhikari S, Amini R, Stolz L, et al. Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. Am J Emerg Med. 2014;32(6):592-5.15. Filly RA. Ultrasound: the stethoscope of the future, alas. Radiology. 1988;167(2):400.16. Parker L, Nazarian LN, Carrino JA, et al. Musculoskeletal imaging: medicare use, costs, and potential for cost substitution. J Am Coll Radiol. 2008;5(3):182-8.17. http://www.company-histories.com/SonoSite-Inc-Company-History.html18. Sharpe RE, Nazarian LN, Parker L, Rao VM, Levin DC. Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices. J Am
Coll Radiol. 2012;9(2):141-6.19. http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum20. Uncertainty and the welfare economics of health care
21. The Unanticipated Consequences of Purposive Social Action
22. Roy JS, Braën C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-
analysis. Br J Sports Med. 2015;49(20):1316-28.
23. Harmon KG, O'connor FG. Musculoskeletal ultrasound: taking sports medicine to the next level. Br J Sports Med. 2010;44(16):1135-6.24. Roach NT, Venkadesan M, Rainbow MJ, Lieberman DE. Elastic energy storage in the shoulder and the evolution of high-speed throwing in Homo. Nature. 2013;498(7455):483-6.25. Dijkgraaf S. Spallanzani's unpublished experiments on the sensory basis of object perception in bats. Isis. 1960;51:9-20.26. Acebes C, Harvie JP, Wilson A, Duthie J, Bowen F, Steven M. Clinical usefulness and patient satisfaction with a musculoskeletal ultrasound clinic: results of a 6-month pilot service in a
Rheumatology Unit. Rheumatol Int. 2016;27. AIUM: Collaboration drives musculoskeletal ultrasound28. Stolz L, O'brien KM, Miller ML, Winters-brown ND, Blaivas M, Adhikari S. A review of lawsuits related to point-of-care emergency ultrasound applications. West J Emerg Med.
2015;16(1):1-4.
29. Nazarian LN, Alexander AA. Denying payments for musculoskeletal ultrasound: how did we get here?. J Am
Coll Radiol. 2010;7(8):553-6.
30. Jacobson JA. Musculoskeletal ultrasound: focused impact on MRI. AJR Am J Roentgenol. 2009;193(3):619-
27.
31. http://www.riskandinsurance.com/little-progress-reducing-shoulder-claims/
32. http://www.ob-ultrasound.net/history1.html
33. http://whywebecamehuman.com/300000-year-old-hominin-spears/
34. http://www.aium.org/resources/viewStatement.aspx?id=51
35. http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/US_Musculoskeletal.pdf