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I'm purchasing a Dx Ultrasound by the end of the year for use in my practice.
Any suggestions from experienced "Ulrasounders" re: type, model, etc.... would be welcome.
Steve

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DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Green Bay, Wisconsin, USA

Hi Steve


Definately!!!!

Do NOT buy anything until we have discussed this though.

I will attach a document which I created for our provincial legislative College with recommendations for US for podiatrists which includes detail of equipment requirements for adequate MSK exams.

There has been some misguided criticism in the popular podiatric press regarding US use (though interestingly this was later retracted though I suspect this may not have been widely noticed).

I would be glad to discuss this in detail publicly though detail over individual companies I would rather keep to private email.

As a generalistionI would add this to anyone considering US.

Equipment selection is absolutely CRUCIAL and if you want to seriously examine anything other than the plantar fascia or tendo-achilles you will need a high end, high frequency machine. Because, as with most computers (US is essentially a specialized computer with a probe attached) the costs of higher power constantly goes down.

I feel we area approaching a time where this is a viable option for podiatrists involved in treating MSK injury. The machine I use was manufactured in 2001, and sold new for $200K USD. I bought it used last year for $20K.

There are a lot of low quality machines being sold for podiatric use with the mantra that this is a nice little earner. What better way to denigrate a useful modality before it gets a chance to be evaluated properly? This is appalling and I feel endangers US reputation, but what’s new?

US is not for the faint hearted, there is a slow steep learning curve and interpretation for me has been slow and hard earned, and continues to be so.

Having said that as my skill and confidence grow I increasing feel that it has huge potential. A problem is lack of formal educational opportunities.

Do not believe that a 1 day course will allow you to go make good decisions with your machine.

Hope this helps

Cheers

Martin


The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
Phone [204] 837 FOOT (3668)
Fax [204] 774 9918
www.winnipegfootclinic.com

Attached Files

Proposal for practice guidelines for accreditation of competence in diagnostic musculoskeletal ultra (45.0 KB, 8 views)

"Do NOT buy anything until we have discussed this though"

OK!
Steve

Related threads:
Plantar Plate Sonography and Histology
Injection vs ultrasound for neuroma diagnosis
Biomechanical challenges - a new model (or just an old one revisited??)
Diagnostic Ultrasound regulations and accreditation
Prenatal ultrasound diagnosis of club foot and counselling
UK Podiatry & Diagnostic Ultrasound

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I have an Aloka SSD-900 that I have beening using for 2 years for diagnostic ultrasound and guided injections. The machine paid for itself in 6 months. At the time I believed Aloka was the best buy, but technology may have changed in 2 years. I definately recommend a course at one of the podiatry seminars and also please purchase a sonography atlas. I use the one from Adler and Softka and find it very useful.

Good luck!

Michael B. DeBrule, DPM
Marshall, Minnesota, USA

Hi Michael

I believe that US is underutilised for Dx of MSK disorders, perhaps this is because it requires a great deal of practice to get reliable interpretation.

I feel that the pod arena would be a good place to engage in constructive critique of imaging interpretation. Given that there is no formal training available other than for radiologists, rhematalogists and physiatrists in N America, and very little elsewhere, I would anticilate most podiatrists using US are self taught which if far from ideal.

Whilst I agree the one day courses are helpful as a very rudimentary introduction to technique and limitations they fall far short of providing adequate training for a clinician at any level to feel competent. Atlases I agree are helpful but having spent some time studying the available literature on the foot and ankle and relied on it for direction, I beleive dialogue with an experinced clinican with live moving images would be far more efficient and effective.

Perhaps there is a small but entheusiastic cohort with some US experience who are subscribing to this forum to engage in some case studies using US , I would certainly enjoy some discussion to hone my own clinical reasoning and I have a sense that there are some who would be interested to see what this might amount too.

If you find this appealing let me know and I'll start up a thread and see what happens.

cheers


Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

I have purchased a mobylis colour one (UK) - is great - portable and was only $28,000 plus tax (including the converstaion rate)
2 probes and all computer connections
no complaints from me

What are you planning to do with your new machine and how will you approach learning the neccessary skills to make good judgements with it?


cheers

Martin

I am going on a 6 month training course - over a number of weekends

training from sonographers, consultant radiologists and physicians.

main use is Dx of nueromas, tendo-achilies stuff and forefoot soft tissue pathology - we also have a big vascular clinic and with the colour flow aspect we could use this also.

main use will be guided injections and will save time on referrals to radiology - for the more simple injections and leave them free to be utilised for themore complex cases.

cheers

M

Please could you let us know more regarding the course, is there a website with info or a contact I could reach.

are you based in Liverool? I used to work at the Royal Infirmary in the real bad old days.

Thanks



Martin

I bought the SIUI greyscale unit. It has a multifrequency probe. The machine is Windows based and is upgradeable as far as improvements in software. I have done 2 upgrades since the purchase and these uprgades were made available for free via email. The unit cost about $10,000 dollars US.

I'd like to suggest that rahter than members simply mentioning their machines they should post some images so that we can compare machine quality.

I would suggest posting the following which give us a good intra-machine comparison.

if operators use their own anatomy we could also make this a vanity show to compete with the openning page from Santa

saggital views of

Insertion of central band of P aponeurosis
Insertion of tendo-achilles
plantar 2nd metatarsal head showing FDL and P Plate insertion into PP

long axis;

Tibial Nerve through tarsal tunnel

short axis;

Tib Post at tarsal tunnel

Power doppler long axis

dorsalis pedis
digital artery

this would give us a nice comparison of resolution and tissue contrast.

Be sure get best possible image quality to make this meaniful

if there is interest in this I'll do same it could be an intersting exercise

cheers


Martin



The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com