getting started with u/s

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NEPain

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It looks like our group is finally willing to go with u/s. It'll probably get bundled, but it still seems like it has a lot to offer.

I am totally unfamiliar with the machines and was not trained in u/s. Any recommendations on machine? Will they train me and will that be enough to get going? Any other tips as we look for a machine and start using it? Thanks.
 
Philips cx-50. You need to go to a course. The reps won't teach you at least not what you need to know. There's a huge learning curve so be ready to put some time into it.

Best course is AIUM. You just missed it. Every July at Mayo.

AAPMR does a good course and AAPM last year was pretty good.

For texts get Jacobson and Narouze's. Malanga is coming out with one this fall.

For website see www.essr.org and go to the education section for each joint. Very high yield.
 
he's brand new to U/S therefore he needs a portable machine, to bring home and learn on his wife and kids 🙂
 
DOctorJay said:
he's brand new to U/S therefore he needs a portable machine, to bring home and learn on his wife and kids 🙂
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Excellent suggestions by DOctorJay.
- Philips cx-50 is a great machine but I would also consider GE logiq e as well. Contact the local reps for Philips, Sonosite and GE and have them bring a machine in to your office
-Ultrasound does have a steep learning curve but the best way to learn is to open Jacobson (http://www.amazon.com/Fundamentals-...15&sr=1-1&keywords=musculoskeletal+ultrasound) and Narouze (http://www.amazon.com/Atlas-Ultraso...15&sr=1-4&keywords=musculoskeletal+ultrasound) and practice on yourself, staff and family.
-There are excellent teachers out there who will come and do a 1-2 days one on one hands on teaching with you and your staff member. The cost can run from 1500-1800 a day.
-Other options for courses are some of the ones offered for a very low price by sonosite and than the gulf coast ultrasound institute (www.gcus.com). American college of Rheumatology and American College of Sports Medicine also offer courses.
-Youtube has tons of videos but they are nicely organized here (http://thepainsource.com/category/ultrasound-2/)
 
if you own an iphone (dont know about android), sonosite has a free ap that shows how to do some of the major blocks. useful when you get one of those "brain farts"...
 
DOctorJay said:
Philips cx-50. You need to go to a course. The reps won't teach you at least not what you need to know. There's a huge learning curve so be ready to put some time into it.

Best course is AIUM. You just missed it. Every July at Mayo.

AAPMR does a good course and AAPM last year was pretty good.

For texts get Jacobson and Narouze's. Malanga is coming out with one this fall.

For website see www.essr.org and go to the education section for each joint. Very high yield.
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l
 
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The more money you can spend, the better you image quality will be. Hand-helds are good for quick-and-dirty injections, but useless for MSK Dx.

Theres a place in St. Pete, Fl that does a lot of US training. I started there, but have also done the past 2 years of AAPM&R mtgs in Vegas.

Some companies will help you find someone to work with you at first when you purchase new. We bought GE LogiQ and they did that for us.
 
what did you guys pay for the GE US?
thanks.
 
Thank you all for the helpful info. Definitely would need the portable if only to go back and forth between offices, but the idea of practicing on family is good.
 
most of the advice above is quite good and I agree. The Phillips CX 50 is a very good machine, however, even though it is in theory "portable" it is a rather large portable. is also a substantial investment and approximately twice the cost of other high-quality portable machines.

I have a Biosound mylab 25 Gold, is about the same size as the CX 50, and in my opinion, a very comparable image quality. This also would likely be too big for you ( unless you were going to bring her family or friends to the office on the weekends the practice, it takes up a small suitcase)

I would give strong consideration to a Sonosite site or GE portable, you should be targeting approximately 35K for the machine with 2 probes. You definitely want a small linear probe and a medium-sized curvilinear probe. don't try to get away with one single probe to do it all, you will regret it.

I would first buy the machine and practice on yourself and friends using the books mentioned above. Do this regularly for a few weeks/months and then start attending courses.

In the name of shameless promotion, I am a course director for a AAPMR ultrasound course in 2013, specifically geared towards pain physicians. check that website for details forthcoming.

other course as mentioned above are good as well
 
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specepic said:
I would first buy the machine and practice on yourself and friends using the books mentioned above. Do this regularly for a few weeks/months and then start attending courses.
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The problem with that is, unless someone shows you what to look for, you have no idea what you are looking at. You don't know "knobology." You don't know how images change as you move or tilt the probe. You develop a lot of bad habits.

What worked for me was taking a course, learning on the paid models they had, then going home and trying it out, then going to another course to build on that, then back home, rinse and repeat.
 
PMR 4 MSK said:
The problem with that is, unless someone shows you what to look for, you have no idea what you are looking at. You don't know "knobology." You don't know how images change as you move or tilt the probe. You develop a lot of bad habits.

What worked for me was taking a course, learning on the paid models they had, then going home and trying it out, then going to another course to build on that, then back home, rinse and repeat.
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A respectable rep is going to show the purchaser the knobs, etc. One is really damned if they do damned if they don't. If you go to a course w/o ever touching a machine you will learn little. If you try to use your machine w/o a course that will also be challenging. I was spoiled by having as attending in resid and fellowship the gurus of US.

The problem with US is that it is very hard to know what you are looking at. It is like searching a room with a very small flashlight, opposed to just turning on the lights and seeing everything (fluoro).
 
PMR 4 MSK said:
The problem with that is, unless someone shows you what to look for, you have no idea what you are looking at. You don't know "knobology." You don't know how images change as you move or tilt the probe. You develop a lot of bad habits.

What worked for me was taking a course, learning on the paid models they had, then going home and trying it out, then going to another course to build on that, then back home, rinse and repeat.
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if you want to work with the machine rather than get all confused and screwed up by the knobology, then look at the GE Venue. It is essentially preset for most of what we need, with some set parameters and programs.

you wont be able to get real fancy with it, but the beauty is, just turn it on and start scanning, and you can focus on what you might be looking at rather than what buttons to push.

combine that with a course, or better yet, follow around some academic ultrasonographers for a few days...
 
I recommend Mindray M7. There were a lot of things I didn't like with GE and Sonosite models. For general MSK and nerve blocks, IMHO the M7 is one of the best models available right now. Also, it's the size of an older laptop, with an easy to carry handle. (The additional footplate is heavier than the actual unit.) Mindray also sent someone for a full day to set up the system to my specifications, and to train me how to use it properly (an added $1500 value). The best thing to do would be to call all the reps and have them bring the units to your office for you to check out, along with multiple probes. Also, if you plan on going to any of the courses, a lot of the reps should be there hocking their wares; it's a great opportunity to try out a lot of different systems and compare. Thomas Jefferson gives a great course on basic MSK US, with the added bonus of being held at the Borgata in AC (if you've never been, it's a real treat; make sure you check out the pool, spa, and poker room, not necessarily in that order). http://www.jefferson.edu/jurei/conference/
 
I just purchased the mylab25gold for 25k with 2 probes. It is marketed by the same company that pushes Mindray. I had 3 demos and went to 2 hands-on conferences with multiple competitors, including GE and Sonosite. Waiting for delivery.
 
thanks, was told only one probe is fine for all msk injections. i will buy both.
trying to get the GE for under 30K at this time.
 
Doctodd said:
I just purchased the mylab25gold for 25k with 2 probes. It is marketed by the same company that pushes Mindray. I had 3 demos and went to 2 hands-on conferences with multiple competitors, including GE and Sonosite. Waiting for delivery.
Click to expand...

Are most of you leasing or buying the machines?
 
I frequently use the curved probe for hips and it's not unusual for me to do a glenohumeral with the curved probe as well. Agree with spec that you should have 2 probes.
 
stim4u said:
thanks, was told only one probe is fine for all msk injections. i will buy both.
trying to get the GE for under 30K at this time.
Click to expand...

I also use a Biosound mylab 25 Gold. Happy with it.
Two probe are needed for sure:

10-14-18 MHz linear array probe for nearly everything
2.5-6.6 MHz Convex Probe for: Hip joint, piriformis, GH, sometimes troch in BMI 40+
 
stim4u said:
thanks, was told only one probe is fine for all msk injections. i will buy both.
trying to get the GE for under 30K at this time.
Click to expand...

Hips can be done with linear, moderate-to-high frequency probes in thinner people. The average American often requires a low frequency/curvilinear probe.

Most everything else can be done with linear probe.

If you want to do fingers and toes, consider a "hockey stick"
 
Would you mind sharing the price for the Mindray?
 
at the last conference i went to they quoted under $10K.....around $7k or $9k if i remember.
 
Any thoughts on the Sonosite S-MSK? My anesthesia buddies have a couple of S-Nerve models for regional blocks, they seem to work well with limited knobalgia. You can mount it on a rolling tripod with the footprint of a Dynamap BP machine.
 
Our hand consultant has one and it is great for very superficial structures. Not sure how well it would do with a hip though.
 
If you do mainly spine related injections, then the ultrasound will never pay for itself. It is a useful, but very overpriced technology, even given the competition between manufacturers. The learning curve is very steep. One of the best ways to discern pathology is to use a left/right screen split and ultrasound the normal side with a freeze frame on one side of the split. This is an excellent way to compare. The more portable the better....larger machines tend to sit in one place and unless your clinic setup is such you have the time and space to allocate one room for US then move your patients from one room to the US room if you decide an US is necessary, then a smaller machine would be better. The GE, Sonosite, and Mindray are all very portable. Some US courses do remain this year and can be seen at http://indianapainsociety.org/index.php/cme/2012-pain-workshops
 
Just so people aren't misled, I spoke with the Mindray rep and the M7 is 35K.

As algos said, this is a useful but expensive modality.
 
Just a quick resurrection of this thread.
I found the books by Jacobson and Narouze. There are some good courses coming up.

Are there any videos that provide u/s training that anyone is aware of? Seems like that would be a good way to learn. It can be so hard to get away to a conference.
 
First, thank you so much for all the helpful info. Several courses were recommended, but unfortunately few are in the near future and close enough to get to.

Any comments on the AAPMU course? They have one in Boston that I could easily get to.
Feel free to IM me if you want.
 
I've been able to have most of the reps come to my office. I've seen the esaote, mindray M7, phlips CX50, GE Logiq e, terason 3200, sonosite M Turbo.

Anyone familiar with the Terason?

If anyone is looking at machines, I'm happy to share what I've learned in the demos. It seems to largely come down to how much control you want to have for diagnosis vs just turn it on and inject.

At this point it looks like the GE, Mindray, and Sonosite are the best, although the Sonosite seems to have very limited ability to make adjustments. It has no moving parts though (except a fan). I'd love to hear about the Terason, good or bad. Feel free to IM me if you prefer.
 
I own the Terason T3000 and have done procedures with the T3200.

They are both great machines for image quality and value and tweakability. They run on Windoze and therefore are fully networkable which is great for image storage. Windoze is fully user accessable. They are not the easiest to operate nor are they the most durable, in fact likely the least durable. However, should something break, you may be able to fix it yourself vs. paying out the butt for a repair. If you have ever worked on a macbook pro you can likely do a lot of repairs that would be needed.

The sonosites are very durable but offer the least image quality and tweakability. They are machines for docs who don't want the best image, just want an easy machine to use. Also way too expensive.

The Philips CX50 has the best image quality and is probably the best overal US machine on the market right now. Really love it, but it was significantly more expensive than my Terason.

The GE units have no advantages. Expensive, lesser image quality, etc.

No experience with mindray.

In process of demo-ing Esaote so no opinions on that yet.

If you can afford it, get the CX50. Sweet machine.
 
Ligament said:
I own the Terason T3000 and have done procedures with the T3200.

They are both great machines for image quality and value and tweakability. They run on Windoze and therefore are fully networkable which is great for image storage. Windoze is fully user accessable. They are not the easiest to operate nor are they the most durable, in fact likely the least durable. However, should something break, you may be able to fix it yourself vs. paying out the butt for a repair. If you have ever worked on a macbook pro you can likely do a lot of repairs that would be needed.

The sonosites are very durable but offer the least image quality and tweakability. They are machines for docs who don't want the best image, just want an easy machine to use. Also way too expensive.

The Philips CX50 has the best image quality and is probably the best overal US machine on the market right now. Really love it, but it was significantly more expensive than my Terason.

The GE units have no advantages. Expensive, lesser image quality, etc.

No experience with mindray.

In process of demo-ing Esaote so no opinions on that yet.

If you can afford it, get the CX50. Sweet machine.
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Biosound/esaote has a v/ similar pic to cx50 at half the price. Machines are about the same size too. Agree re sonosite pic quality. Biosound x 2 + years and happy. Two probes a must IMO. I use my machine 2-6x/day and it has held up well.
 
Thank you both. For some reason, the only other person involved in making this decision got a very poor impression of Esaote. Not sure why. I'll pursue that.

How do you guys get the images to your EMR? Do you have DICOM? I'm figuring that I'll just write a procedure note in the EMR and then have someone make sure the images each day are transferred as jpg or pdf files to the patient's chart in the emr.
 
I bought the cx50 after looking at several machines. Very happy. Easy to use and great pics.

I taught a workshop last weekend and GE was the sponsor. I used 3 versions of their machines and they didn't compare. However for the cadaver portion they let me use the $80k top of the line with 4-5 probes attached and it was amazing. However likely the top end of any manufacturer will be pretty good.
 
NEPain said:
Thank you both. For some reason, the only other person involved in making this decision got a very poor impression of Esaote. Not sure why. I'll pursue that.

How do you guys get the images to your EMR? Do you have DICOM? I'm figuring that I'll just write a procedure note in the EMR and then have someone make sure the images each day are transferred as jpg or pdf files to the patient's chart in the emr.
Click to expand...

We just use a memory stick, one actually comes with the machine too but I'm sure others would work. I would also say I have been blown away by the machines memory, I have been using it for 2+yrs and the memory is not full yet. You also have the option of the machine downloading to a CD, I have not done that though.
 
I've now seen all the machines discussed. The sonosite was actually the least expensive. I love that it's all solid state. Soon, all the machines will have SS hard drives. Not for now though.
Most of the machines are in the same price range with one transducer. The price of a second ducer varies quite a bit. Philips is indeed the most expensive machine all around.
My concern is that a lot of people will be using the machines I buy, so I'm leaning towards rugged and simple=sonosite M Turbo. The image quality worries me. Does anyone use this machine and would anyone advise strongly against it? I've been told that it might have trouble doing an abdominal nerve block in an obese pt, for example. Thanks again for all the great help. If you belong to a purchasing organization you can get a good deal. Also, many will provide training, even fly you to the course.
 
Old thread. I'm looking at a Terason 3200 (demo unit/floor model) for $15K.

Opinions?
 
Disciple said:
Old thread. I'm looking at a Terason 3200 (demo unit/floor model) for $15K.

Opinions?
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I got contacted by a rep about the same thing you are mentioning. I always wonder about reliability. it might be worth it to buy the extended warranty but they are not cheap. the model you are mentioning has a great picture but the tray with the knobs/buttons that slides in and out can get stuck/broken.

one thing i like about that model is that it feels lightweight compared to others. it is built into a mac book and overall has a small profile, if portability is an important consideration for you.
 
i just can't find the love for terason machines
 
I teach at NWAS occasionally (am teaching this weekend in Vegas) - then hanging out for painweek. If I am not there, all the guys at the vegas and most west coast courses are from our pain clinic. they would totally show you some stuff.

Go to one of those and pull me aside - I'll show you all the MSK stuff (because the main program is about regional). learning a particular block isn't the problem...learning to use ultrasound is the key and how to look at an ultrasound image. After that, learning the particular block is fairly easy with youtube.

Another great course is the SPPM. Some of my colleagues teach at that as well.
 
oreosandsake said:
I got contacted by a rep about the same thing you are mentioning. I always wonder about reliability. it might be worth it to buy the extended warranty but they are not cheap. the model you are mentioning has a great picture but the tray with the knobs/buttons that slides in and out can get stuck/broken.

one thing i like about that model is that it feels lightweight compared to others. it is built into a mac book and overall has a small profile, if portability is an important consideration for you.
Click to expand...

Can't find any decent refurbished machines (multiple brands) for less than about 8K. Will probably just go with this deal. Half-off for a machine with low usage, not bad.
 
Disciple said:
Can't find any decent refurbished machines (multiple brands) for less than about 8K. Will probably just go with this deal. Half-off for a machine with low usage, not bad.
Click to expand...

8 or 18?

I'm looking at a used mindray m7. I think it's a better machine. my guy might have another one if you want his contact...
 
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