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Ultrasound Testing(Inappropriate Uses)
Introduction Ultrasound testing (commonly called sonography or ultrasonography) is performed with a device that transmits sound waves through body tissues, records the echoes as the sounds encounter structures within the body, and transforms the recordings into images that can be viewed on a television screen, recorded on videotape, and printed. Continued improvements in ultrasound technology have increased the number of things ultrasound can be used for. However, ultrasound currently has limitations and is not useful for imaging some areas of the body. Some practitioners, medical as well as chiropractic, are using ultrasound testing for money making purposes by claiming that it is useful for diagnosing muscle spasm or inflammation and for following the progress of patients treated for back pain. Standard medical textbooks, radiology organizations, and even mainstream chiropractic leaders do not regard ultrasound testing as useful for these purposes. [2,3,4,5] What is Ultrasound useful for? Diagnostic ultrasound is a valuable tool in diagnosing normal and abnormal conditions in the following situations:
What is Ultrasound not useful for? Ultrasound has not been shown to be useful for imaging the spine and surrounding tissues including nerves, connective tissue, facet joints and paraspinal muscles. There is insufficient evidence in the peer-reviewed medical literature establishing the value of diagnostic spinal ultrasound. Ultrasound is best able to detect surrounding tissues and structures that have differences in their density and thus echogenicity. For example, gallstones and kidney stones can easily be distinguished from surrounding tissues of different densities. Likewise, fluid filled structures such as the pumping heart or pregnant uterus provide an ideal interface to distinguish between liquid and solid structures. Adjacent structures of very similar density (or echogenicity), such as muscle and connective tissue can not be easily distinguished from one another. Ultrasound is not currently useful for imaging air filled structures, such as the intestines or lungs. When to Suspect Fraud Inappropriate sonography is most prevalent in cases involving personal injury cases. [1] In rare cases, a single ultrasound examination could conceivably be useful for investigating a serious muscle injury or a large blood clot (hematoma). However, spinal ultrasound examinations that are done routinely (on most patients), that involve many different parts of the body, or are repeated "to follow the patient's progress" after an accident, have no scientific rationale and should be considered financially motivated. References
2. Haldeman S and others (editors). Guidelines for Chiropractic Quality Assurance and Practice Parameters. Gaithersburg, MD: Aspen Publishers, Inc., 1993.
4. American College of Radiology. Ultrasound: Not effective in diagnosing spinal injuries. ACR Bulletin 2-96.
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Modified: February 3, 2002