Talking about ultrasound, J.K. Waldsmith, DVM, gets in the zone. Referring to what is often called "zone technology," Dr. Waldsmith, president of Vetel Diagnostics in San Luis Obispo, Calif., will tell you that the biggest thing right now in the world of ultrasound is sound speed corrected ultrasound systems. "These are solid state systems that run on DCP (driver compatibility program) chips and microprocessors, not boards with firmware," Waldsmith said. "They are able to calculate the speed of sound on a pixel-by-pixel basis and apply a display algorithm based on the speed of sound in the tissue at each specific location throughout the image." The result is a clear and distinct image that is uniform in detail, which Waldsmith said is impressive on both shallow and deep structures. Additionally, he noted, the technology eliminates the need for the time consuming process of applying focal zones to an image, and also making time gain compensation adjustments. What does all this mean to veterinarians interested in ultrasound technology? Thanks to its increasing affordability, non-invasive nature and rapid delivery of soft tissue anatomical information, the technology is easily accessible and usable by the typical veterinarian. And thanks to its improving quality, ultrasound is becoming an increasingly powerful diagnostic tool, Waldsmith said. Diagnostics "The practitioner now has the ability to perform many diagnostic and therapeutic procedures under ultrasound guidance, which before were either outsourced to a specialist or not performed at all," Waldsmith said. "Now such procedures as ultrasound-guided biopsies and needle aspirations are routinely done in general practice." Furthermore, the emergence of regenerative medicine, with methods like platelet-rich plasma and stem cell therapies, requires the precise delivery tool that ultrasound provides, according to Waldsmith. Waldsmith believes the possibilities that such real-time technology will provide will become even more important for veterinarians in the future. "Very soon it will be possible to have the ultrasound online, and a specialist will be able to remotely log in and assist the practitioner in both performing and diagnosing real time during the patient exam," he said. "This will bring a new level of readily available expertise to everyday practice, at the same time greatly increasing the access to opinions from other experts." The tremendous improvement in the quality of images is what most excites Eric Lindquist, DrMedVet. However, Dr. Lindquist, incoming president of the International Veterinary Ultrasound Society for 2013/2014, was also a bit cautious about the technology. "Machines are coming out with brilliant images and I am finally seeing the progress emphasized on improving core images and processing speed as opposed to new bells and whistles," Lindquist said. "I am very excited about the new images I am seeing from around the world from different machines. That said, I see new strange software glitches that pop up and variable abilities of the ultrasound companies to fix the issue rapidly." Lindquist, the founder and CEO of Sonopath-Vetsymphony.com, also brings up the issue of the ongoing relationship between consultants, highly trained in the operation of sophisticated equipment and able to spot problems that may otherwise go unnoticed, and the general practitioner who is now being offered stronger diagnostic tools. "They are bringing it more in house and it's a huge opportunity for the industry, but it will also challenge specialty facilities as well, because the sonogram will be referred out less and less," Lindquist said. "This creates a different series of challenges for the in-house general practitioner and technicians to perform at a very high level, if possible, to avoid garbage-in, garbage-out scenarios that only hurt the pet and the industry as a whole." There's nothing wrong with general practitioners who want to bring more ultrasound capabilities to their clinic if they are fully capable of handling such cases, and diagnosing efficiently and correctly while treating the animal, Lindquist said. But, he added, "Many do not know what is truly happening to the patient and sit on the case too long." Education That lack of knowledge concerns Anthony Pease, a veterinary radiologist at Michigan State University and president-elect of the American College of Veterinary Radiology. "There is still a disconnect," said Pease, past president of the Veterinary Ultrasound Society. "Older practitioners have never been trained on ultrasound and more recent graduates are given exposure to ultrasound, but with all the other requirements to their training, it is generally an elective for students and is not a requirement." Those behind the times on the technology may want to take notice, because the pace of its development isn't slowing down one bit. Ultrasound continues to offer ever-more powerful diagnostic tools for vets looking to offer patients more and higher quality services, he said. "Ultrasound continues to grow in leaps and bounds and it usually exceeds the speed that we can evaluate the technology and understand it," Pease said. "Currently, the use of contrast medium in ultrasound and measuring the elasticity of organs to determine if cancer is present is offering a huge benefit to keeping ultrasound a non-invasive method to evaluate animals." Pease also emphasized there is a large learning curve, and to make it worth the purchase of a typical $30,000 to $50,000 ultrasound machine, it requires training of a veterinarian or technician at least every six months in one of the ultrasound courses offered by most major vendors. But learning to use the equipment is just the start. The bigger challenge is to learn how to interpret the information, Pease said. Thanks to the availability of RACE-accredited online continuing education, imaging workshops and wet labs, it is now relatively easy for busy veterinarians to obtain the necessary information required to confidently employ diagnostic ultrasound in their practice, said Vetel's Waldsmith. It's the Economy Cost of equipment is also waning as a factor keeping vets out of the ultrasound realm, according to Jennifer Kaminski, marketing and communications manager for scil Animal Care Company USA of Gurnee, Ill. "High-end portable systems can cost less than $50,000 and perform better than many traditional cart-based systems," Kaminski said. "Portable units are capable of everything from abdominal and cardiac studies, to elastography—an ultrasound technology that could hold a bright future in veterinary medicine." Aside from elastography, a non-invasive method of detecting tumors, musculoskeletal imaging is being used more by practitioners, and focused assessment with sonography for trauma is becoming more popular in emergency veterinary care, Kaminski said. "With the state of the economy, some veterinarians are finding that investing in ultrasound equipment provides a new source of revenue, while improving the level of medicine that they can provide to their clients," Kaminski said. "In a market flooded with veterinarians, the ability to provide ultrasound-related procedures has proven to be a differentiator from surrounding clinics, and may attract prospective clients to their facilities." Perhaps what has stopped more veterinarians from jumping into ultrasound recently was the cost, and the questionable economy has seen practitioners holding off on purchasing equipment. But that won't be the case for long, Waldsmith said. "As consumer confidence grows and veterinarians feel secure about the recovery and ability to financially service the costs of ownership of imaging technology, we will see an increase in the utilization of all forms of diagnostic imaging modalities," Waldsmith said. He also has some advice to vets getting ready to jump into ultrasound and make the big ticket purchase. "To the practitioner, I would offer the following for consideration: Buy the best ultrasound system you feel you can afford," Waldsmith said. "There is a direct correlation between the quality of the image and the cost. A high-quality image will inspire confidence in the practitioner utilizing the ultrasound system, and as such they will be more inclined to use it. That will create the revenue to support the purchase of a high-quality system."
