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Fuma said:
No and yes. Just because Ultrasound is available, doesn't mean it's performed and read expeditiously. It's usually a minimum of 45 minutes from order to study to read and that's on the hyper efficient side. For many studies (dvt, ocular, soft tissue for abscess or foreign body), it takes longer to figure out how to archive the images than to do the study!

The extra steps in the workflow is why alot of phantom scanning happens. Additionally, I think youre very correct that it's the willingness of the operator. I wrote a lengthy post on a paid board about this. Were pretty pennywise pound foolish on this- no matter how optimized the health system, no way you can order, perform, and read a soft tissue study study faster than I can do and save an exam! Yet this happens on the end of the would be POCUS clinician all the time. It's a bit of pin the tail on the specialist, despite pretty good evidence that POCUS can be useful for specific indications.

I guess I was specifically thinking about the OR or ICU where they are trying to do procedures. Our ERs generally do some scanning but don't save any images and use it more as a triage method. If they see anything they order a formal ultrasound. I suppose if those clinicians are willing to act on what they interpret then it saves time.

As for the mental barriers of utilizing POCUS, getting it into the hands of students flattens the curve a bit. And ease of saving and archiving helps. And butterflyIQ has done a masterful job of becoming an Apple-like company amongst the crowd with a cool factor to it. Not that it's a reason to do it, but many more EM residents know what the butterfly is, and next to none know about lumify, clarius, vscan, or Vave.

This is ultimate goal, I just wonder how many people will carry that through. When I was training, various services used ultrasound for procedures. Every medicine resident learns to put in a central line and do a paracentesis and an LP. But now somehow they've all forgotten how to do it (probably insurance related Alzheimer's). Maybe there's a gradual effect and some maintain those skills, but I have to see it happen. I saw it work with ISRG (urology residents who basically only looked for jobs where they could use Da Vinci). But I suspect at the end of the day it comes down to money (and by extension liability).

Alan said:
Not really. A few drops of water on the skin work just as well. That's a trick taught me by one of our locals radiologists. But I'm guessing you knew that, right? You're moniker is IRdoc. I assume you're an Interventional Radiologist.

Sure, as long as you can get good opposition of the probe with the skin and a layer of liquid in between it works. Without trying out the probe, it's hard to know. Yup, I'm an interventional radiologist.

We save our images, but no one has ever looked at them in retrospect. For now, it's a formality.

I agree, it's mostly a formality. For procedural guidance it probably doesn't matter. But if someone is doing an echo or looking for gallstones and billing for it, they probably need to save images. Then it's a real possibility that someone will find out they have liver cancer, remember some guy in the ER did an ultrasound of that area, and wonder why it wasn't picked up. Considering how many dubious indications we get for imaging (head scans for the drunk guy, ultrasound for a spider bite) it seems pretty clear that litigation is still a strong concern.

I honestly believe using an ultrasound will become part of all medical training. It is already widely taught in many (most?) residency programs.

It's certainly going to be part of the training, but to use it enough gain widespread adoption is another issue. Everyone learns to use an ophthalmoscope in med school but how many people ever buy a second one?

I use the Butterfly for virtually all of my real-time procedures (nerve blocks: central line and arterial line placement; difficult peripheral IV starts; volume status). I just lay my cell phone on the bed/patient nest to the procedure site.

I saw a video of someone who did that, just placing the phone on the bed. Most of my procedures are more involved, so using the bed is not really an option. Of course we have easy access to ultrasound machines as well.

....every person has large veins that are "deep"....but (fairly) easily accessible under ultrasound guidance.

Not every... I've had to do more than a few translumbar direct IVC punctures which are not easily accessible.


What's their potential market? According to Google, the stethoscope market is $500m or so. It's for stethoscopes that cost a fraction of the Butterfly, but there are a lot more stethoscopes lying around.

I'm with Denny on this one, I'd like to see them actually making sales and converting them to subscriptions before investing.
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