Use and abuse of ultrasound exams in practice

RE: Use and abuse of ultrasound exams in practice

Anthony Dennison — Thu, 21 Nov 2019 13:05:40 GMT

Completely agree. I'm the competent scanner in my practice so will often be asked to scan things, and almost always double check everyone else's scan images.

We were getting a lot of dogs being booked in for abdominal scans because of acute diarrhoea that hadn't resolved from initial symptomatic treatment. I put my foot down and said unless there is any other clinical reasoning for the scan, we shouldn't be doing it.

RE: Use and abuse of ultrasound exams in practice

Sarah Keir — Thu, 21 Nov 2019 11:12:54 GMT

I am also worried about this move to CT scanning everything. I have seen lists of 'cases where CT should be used' type and I am concerned that like with ultrasound, the push will be to CT asap and miss out the important steps (sometimes including thorough history and clinical exam).

RE: Use and abuse of ultrasound exams in practice

Julie Innes — Thu, 21 Nov 2019 10:29:34 GMT

We do have ultrasound, and I'm happy to have a look at liver/ spleen/ uterus/ scan for fluid chest or abdomen, but I know my limitations! We have someone who comes in to do more detailed (and especially heart) scans (although I did once spot an intracardiac mass once, confirmed by expert- very proud!)

Definitely useful in 1st opinion practice for free fluid, splenic mass, pyo, pleural effusion, bladder, prostate, big liver masses etc, but I agree you should only look when you have a suspicion of what you are looking for!

RE: Use and abuse of ultrasound exams in practice

Jill Butterworth — Thu, 21 Nov 2019 10:26:21 GMT

Paddy Mannion's Diagnostic Ultrasound in Small Animal Practice is very good and scanning every bitch spay before you open up is helpful.

RE: Use and abuse of ultrasound exams in practice

Bob Russell — Thu, 21 Nov 2019 10:03:21 GMT

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[quote user="Sarah Keir"]

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There are a lot of vets who can do some scanning but not a huge number who are excellent at it. So often results from scans can be a bit ambiguous or ‘this is abnormal but not sure why or how important’.

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Don't knock it until you have access to someone who can perform a good quality scan. Those people have to learn to get to that state too and that involves LOTS of practice - there is no two ways around it, to get good at ultrasound you have to do lots of ultrasound exams.

Also ultrasound is often mis-understood. Yes, it can give a diagnosis e.g. PSS but it is often complimentary to other investigations and diagnostics and so expecting it to give the answer on its own is misunderstanding it. It doesn't for example give a cellular diagnosis so I could tell you the liver is hyperechoic, more white, because it has more cells or fibrosis and the common causes are x,y,z but I cannot tell you the exact cause without a biopsy. But would you go straight to biopsy? In some cases, yes.

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Maybe I didn’t explain myself very well, sorry.

-I’m not knocking ultrasound as a whole.

-I do have access to someone who can perform a good quality scan (a number of people to be fair).

-I understand it takes a lot of practice to get good at it.

-I’m not expecting it to give the answer on its own (occasionally it will).

I agree with most of what you say-although I have (I think) a slightly different take on it!

I agree that ultrasound is often misunderstood. You mention it’s complimentary to other investigations. I completely agree. What I’m questioning is whether it’s used in the right circumstances, or whether it’s relied on too often and used as a fishing exercise. Because then it becomes difficult to interpret the findings (or add anything extra to the info you already know). This then can be a source of frustration (especially if there isn’t someone excellent at ultrasound in the practice to learn from), as per my initial response.

By the way-I’m only guessing it can be a source of frustration, but the impression I get from a number of younger vets about it it seems to be a recurring theme!

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Tangent of: RE: Shortage of vets

In view of this not being related directly to the thread on shortage of vets, I have created a tangent.

As someone who does ultrasound examinations to a high standard (I hope, no letters after my name for this) I am also frustrated when a colleague sends a case my way for a vague sign and a hunt. I first of all repeat a thorough clinical exam and it is surprising the number of times I find more clues. Also clients expectations have not been managed - they are paying ££ for a test and have been lead to expect that it will give the answer. And don't get me started about not being prepped for extensive fur clipping or sedation!

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I am all too guilty of the crime of sending patients at a relatively early stage for imaging etc.

Sometimes it is just pressure of workload and knowing better care can be offered elsewhere so don't automatically think badly of clinicians that do this.

Now 'we are two' here it is obvious that we can do more (and better) in house than before. A bit scary getting my act together!!

Sadly ultrasound is still a mystery to me but time to figure out how to do it better!