Jan 29, 2015
Ultrasound Gaining Support

In recent years, the use of ultrasound imaging in sports medicine has quickly gained in popularity. It is more cost-effective, safer, and more portable than more traditional imaging methods such x-rays and MRIs. Though its detractors claim ultrasound images lack accuracy and can only be read by skilled operators, physicians and sports medicine practitioners recently came together at the Ultrasound First Forum in New York to speak out in support of it.
Both diagnostic ultrasound and MRI are used to examine a variety of injuries. However, MRI testing is significantly more expensive. The machine can cost a hospital upwards of $1 million, and an individual exam may cost thousands. Ultrasound machines are much smaller and cost less, therefore the images they produce are less expensive. Still, MRIs are used more frequently.

Dr. Levon Nazarian, a radiologist at Thomas Jefferson University in Philadelphia, and speaker at the forum, says this practice goes against the norm. “Usually, we like to do the less expensive test first, but in musculoskeletal, we definitely do the most expensive test first, and we do the less expensive test if indicated,” he told DOT Med News.

When compared to an x-ray, ultrasound may be safer. Unlike the ionizing radiation used in an x-ray, an ultrasound utilizes sound waves to capture images. The two health risks sometimes associated with ultrasounds are burns and cavitations–the creation of air bubbles due to shockwaves that can collapse and injure nearby tissue.

However, according to Frederick Kremkau, electrical engineer and professor at Wake Forest University School of Medicine, the health concerns associated with ultrasound are unfounded. “There’s no known risk to the use of ultrasound in how we apply it today,” he told the forum, pointing to the use of therapeutic ultrasound to heat up sore limbs, and High-Intensity Focused Ultrasound to destroy tumors and uterine fibroids.

The use of ultrasound could prove to be especially beneficial in sports medicine because of its portability. While x-rays and MRI machines are stationary pieces in a hospital or clinic, ultrasound devices can be transported nearly anywhere, including the sideline, to obtain real-time evaluations.

Though not affiliated with the Ultrasound First Forum, Dr. Robert Agee uses the GE Logic E ultrasound at Lemak Sports Medicine and appreciates the flexibility it gives him. “

You can take it anywhere,” he told the Birmingham Medical News. “Really, you could have it on the sidelines for acute injuries at sports events. You don’t have to plug it in; it can run like a laptop.”

Neither Melanie Hof, MS, ATC, nor Dr. Ken Mautner of Emory Sports Medicine were involved with the Ultrasound First Forum, but they appreciate the immediate results they get from ultrasound in the field.

“One of my favorite advantages–and one our patients appreciate as well–is the instant gratification we get with an ultrasound,” she wrote on AdvancingYourHealth.org. “There’s no waiting for a report on an MRI that is just a static snapshot of one moment in time. [Athletes] can point to where [they’re] hurting, and we can immediately get a look at that precise area, in real-time motion, as [they’re] moving and experiencing the pain… ‘Mystery pains’ with no clear cause often reveal their secrets to the ultrasound.”

Detractors of using ultrasound claim it will never overtake MRI in assessing injuries because it lacks accuracy. Although ultrasound is not successful in scanning areas filled with air or bone, it can provide incredibly useful images of soft tissue injuries.

When it comes to identifying torn rotator cuffs, a study published in the June 2009 issue of the American Journal of Roentgenology found that MRI and ultrasound images were almost equally accurate. Both had an 85-percent sensitivity and between a 90- and 92-percent specificity in finding the injury. The study supported both imaging methods as effective diagnostic tools.

Others claim that the use of ultrasound technology in sports medicine is dependent on the skills of the operator, an individual who must go through extensive training. A popular solution to this problem was suggested at the forum by Dr. Alfred Abuhamad, President of the American Institute of Ultrasound in Medicine–encourage the accreditation of more facilities in ultrasound.

However, until that happens, Hof and Mautner are providing another solution: teamwork. With her athletic training skills and his knowledge of reading ultrasounds, she explains how they provide efficient care for their patients.

“Dr. Mautner can show [athletes] pictures from the ultrasound right there during the appointment and explain to [them] what he sees. It’s always interesting to watch him take a picture that might first look like a confusing blob to most of us–then he explains the picture in such a way that patients can see what he’s seeing in it and understand what’s wrong. (I stick around after he leaves to answer any further questions patients might have about the ultrasound or their injury.) I love this aspect of diagnostic ultrasound. Often, in the span of a single appointment, we can hear what’s hurting, take a look at the affected area, find the problem, show it to [the athlete], and come up with a plan of action. It’s much easier for everyone involved.”

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