Nonradiologists perform most ultrasound-guided procedures

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Nonradiologists executa a maioria de procedimentos ultrasound-guiados

por Loren Bonner, DOTmed News Online Editor | November 05, 2013
Ultrasound-guided procedures increased almost 100 percent from 2004 to 2010, according to a study published in the November issue of the Journal of the American College of Radiology.

But think again if you believe radiologists — or even surgeons — are doing all these procedures. The study found that nonradiologists, such as anesthesiologists, rheumatologists and internal medicine physicians, performed most of them. The study showed that in 2010, nonradiologists as a group performed more ultrasound-guided procedures than radiologists for the first time ever. But it's a trend that concerns researchers since it's uncertain who has been trained or certified to perform such actions.

Any procedure where a clinician uses an ultrasound for assistance constitutes ultrasound-guided. Some of these procedures include helping to place needles or a catheter or to inject medication, and they all fall under just two CPT codes, making it difficult to know precisely which procedures are being done. But study researchers were able to determine from the codes that nonradiologists were performing most of the ultrasound-guided procedures.

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"We saw they are using them with high frequency and we wanted to encourage further research to understand if these additional processes are adding value to health care systems and if patients are having better outcomes," said Dr. Richard Sharpe, a radiologist at Beth Israel Deaconess Medical Center and lead author of the study.

Without adequate information, he said it's uncertain to know whether the additional expense of using ultrasound to guide procedures is leading to better outcomes for patients, although the overall belief is that it does.

What is known is the ubiquity of the ultrasound machine — it's portable, easy-to-use, and widespread. Sharpe said some manufacturers have even begun to market the machine directly to nonradiologists.

"With relatively low start-up costs, this can represent an additional service that nonradiologists can provide in their office setting," said Sharpe.

A 2011 study Sharpe was also involved with found evidence that nonradiologists who have their own equipment are also more likely to self-refer and get more income that way.

Researchers also acknowledged that it's likely that many procedures that were previously performed without U.S. guidance are now being performed with U.S. guidance.

"We think further research is needed to understand precise clinical indications in which these procedures are being performed and also to know whether the addition of ultrasound guidance is improving patient outcomes," said Sharpe.

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