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SHOULD A CONSULTANT OR SONOGRAPHER PERFORM THE DUPLEX ULTRASOUND SCAN?

All our consultants and some of our nurses are highly skilled in Colour Duplex Ultrasound Scanning. This is an essential part of the patient’s assessment in order to define exactly what is causing the problem and determine what treatment is required and precisely where.

We have seen rather disparaging and misleading comments by another company claiming that doctors are not capable of undertaking quality Duplex Ultrasound assessment! This is arrant nonsense and must be challenged.

Vascular Interventional Radiologists have extensive experience throughout their training in Duplex Ultrasound and historically undertook all such diagnostic scanning. As demand for these procedures increased the radiologists started training technicians (sonographers) to undertake these scans and most ultrasound scanning departments are still led by a consultant radiologist. To suggest that the vascular radiologists are somehow less skilled than the sonographers they trained to help with the increasing workload is ridiculous. (This is not to knock the sonographers, who do a fine job, but to expose the spin from those who did not possess the necessary skills and relied totally on sonographers undertaking the scanning, and who now try to claim that use of sonographers is the gold standard and doctors cannot perform their own scans).

The truth lies elsewhere. Surgeons who wanted to undertake Endovenous Ablation had no training in ultrasound and were forced to rely on the sonographers or radiologists to undertake the scanning for them; and many still do. This is not the best way to plan treatment. In our view it is far better for the person undertaking the treatment to also undertake the scan so that they have a perfect picture in their head of what the scan shows. To rely on a written report from a third person to plan treatment is less than ideal. Judgments need to be made as to the relevance of what is detected on the scan. To treat all abnormalities that a sonographer may detect without assessing their importance and relevance to the condition the patient is complaining of will lead to unnecessary overtreatment. Following such a policy may be great for the finances of a company, but is certainly not in the best interests of the patient’s health, comfort or bank balance.

Fortunately most doctors, be they surgeons or radiologists, who undertake Endovenous treatments in the UK now do perform their own scans and are perfectly capable of so doing.

The involvement of sonographers gets more intriguing! Some doctors without a natural background in ultrasound scanning and its use in guiding interventions also use sonographers to guide them during the procedures. The sonographer holds the ultrasound probe and the surgeon places the needle. This is not only highly inefficient (two persons rather than one to do one task) but also illogical. One brain operating two hands (right hand with the needle left hand with the ultrasound probe) is, in our opinion, far better than two brains operating two different persons’ hands! The latter is what a well publicized trademarked “protocol” advocates. Another reason why it costs a fortune!

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