Neural-scan

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This is kind of funny because we just had grand rounds by Dr. Dillingham from MCW who lectured on the state of electrodiagnostic services in the U.S. Basically about the prevalence of unethical practices in electrodiagnostic medicine including mobile NCS units, hand held devices like the neural scan, and untrained people performing NCS/EMGs. I would be skeptical of any machine that is supposedly able to diagnose conditions without some kind of cerebral input from a neuromuscularly trained physician. Also, would you want to have radiculopathy diagnosed by this machine then go on to surgery?

It takes years of training to become a competent electrodiagnostician. This machine sounds like one of those gimmicks used solely to increase profit for a practice.
 
axm397 said:
This is kind of funny because we just had grand rounds by Dr. Dillingham from MCW who lectured on the state of electrodiagnostic services in the U.S. Basically about the prevalence of unethical practices in electrodiagnostic medicine including mobile NCS units, hand held devices like the neural scan, and untrained people performing NCS/EMGs. I would be skeptical of any machine that is supposedly able to diagnose conditions without some kind of cerebral input from a neuromuscularly trained physician. Also, would you want to have radiculopathy diagnosed by this machine then go on to surgery?

It takes years of training to become a competent electrodiagnostician. This machine sounds like one of those gimmicks used solely to increase profit for a practice.
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First off...up front, I agree with most of what's been said. But let's look at "ideas" from another angle, whether they are upcoming, struggeling, or dismal.

Are we completely satisfied with current solutions?....should we be? In my opinion, its often tough for docs to step out of the box and entertain new ideas for diagnosis and treatment. We should always be skeptical (we are scientists first), but open to the progression of ideas.

But, I believe it is not in the interest of the progression of ideas to completely bash a potentialy new and useful technology before more is understood. New information/technology/treatment deserves a closer look with the scrutiny of good science before it's either placed on a pedestle or bashed in public forums.


Is this a "gimmick to solely increase the profits of a practice"? That sounds like a defensive statement, with no reasonable objective proof. Afterall, in this case, if this machine is indeed significantly more sensitive for the diagnosis of radiculopathy then conventional electrodiagnostic studies, that would make a lot of electromyographers uneasy, to say the least. Independent bodies such as the AMA, FDA, and most insurance carriers (according to the neuro-scan website) have already screened and approved its use in clinical practice.

Regardless, I believe the neural-scan has no potential to replace EMG/NCS studies, at most it has the potential to enhance the sensitivity of our neurologic physical exam.


In my opinion, the scientific theory is interesting for the neural-scan, as well as, its design and ease of use, but the design for its clinical trials, thus far, are laughable and should be embarassing to the company and to any official body condoning its use.

To my knowledge, application for the neural-scan has not been proven by other than anectodotal evidence and a few trials, but then again it has not been disproven at all.

check out this website and go through the on-line video presentations found at the following website:

http://www.sensorymedicine.org/video.cfm

Thoughts?
 
I agree that physicians in general, and physiatrists in particular, should be open to new technologies. If new techniques are developed that make some of our core skills obsolete, we should be willing to use the technology in the best interest of the patient.

But due diligence also requires a full assessment of the value of new technologies.

Particularly in the case of radiculopathies, the pushing of new technology is FAR ahead of the science. The Wall Street Journal, for example, has several articles a month detailing the development of new surgical hardware, stand alone hospitals, new nerve tests, all developed for the purpose of more aggressively profiting from the high incidence of low back pain.

As one of my mentors in residency was fond of saying, for any disease, the more differences in opinion that exist, the less is actually known about the disease. Low back pain is the most clear example of this.

The initial sensitivity of a test reported in the literature should always be viewed with some skepticism. All new technologies have high sensitivity when first introduced, and often decrease in sensitivity as other clinicians attempt to replicate the results.

More importantly, in the context of radiculopathy, reports of sensitivity are highly dependent on the gold standard to which they are compared. And there is no great gold standard for radiculopathy. Nerve conduction studies, late responses, EMGs, MRI, appearence on surgery. and clinical assessment (history and physical) all have flaws. So the sensitivity is being gauged on a fuzzy standard, and therefore by definition will have some unreliability built into the measure.

Finally, one has to consider the incredible amount of fraud associated with electrodiagnostic studies. As noted by AXM, Dr. Dillingham and other's within the AANEM leadership have been aggressively documenting and attempting to block fraudulent electrodiagnostics. There has been a proliferation of mobile labs without physician involvement, unproven technologies, and shady practitioners who have worked to compromise the integrity of the electrodiagnostic evaluation in the name of milking the reimbursement system.

>Independent bodies such as the AMA, FDA, and most insurance carriers (according to the neuro-scan website) have already screened and approved its use in clinical practice.

Just because something is FDA approved does not mean that it is appropriate for making diagnostic decisions. F-waves are also FDA approved and has an ok sensitivity for radiculopathy. It's also an inappropriate test for ruling in radiculopathy, because of it's poor specificity. And again, the sensitivity has to be taken with a grain of salt, because there is no definitive gold standard.

> In my opinion, the scientific theory is interesting for the neural-scan, as well as, its design and ease of use

I am also skeptical of it's ease of use. The electrodiagnostic machine also seemed easy enough to use, until I started seeing patients with anatomical anomalies, multiple concommitant disease, or severe disease that affected the waveforms. Fortunately, I had a quality residency training that prepared me for dealing with the technical difficulties.

Who knows what technical difficulties are associted with this device? Do you really want to trust your physician extender to be making clinical judgments using this device just because the manufacturer claims its easy to use?

I'll keep an open mind, but I want to see more
 
wscott said:
Hey everybody,

Have you heard of Neural-scan?


What do you think of it?

Is anybody using it?

They had a booth at the ISIS meeting in Salt Lake City and it drew a lot of attention.

I'm very skeptical......
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technically, this is a duplicate post on two forums: http://forums.studentdoctor.net/showthread.php?t=301591
but, since it is generating discussions on both forums (pain management and PM&R), I'll let it stay.

I understand that this is based on research coming out of LSU where you trained so you may have more insight into this technology and machine.

I was just alarmed by some of the contents on the neural scan website like:

"Reimbursable: One or two tests covers lease/purchase payment.
Disposable Cost: 50 cents per patient.
Earns More: Based on AMA Guideline sensory EDX is more appropriate and earns more per hour than MRI machines costing 100 times more."

"The Neural-Scan Nerve Conduction Study sensory (NCSs) exam is a simple painless test, your nurse can easily learn to perform in an hour."
 
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axm397 said:
technically, this is a duplicate post on two forums: http://forums.studentdoctor.net/showthread.php?t=301591
but, since it is generating discussions on both forums (pain management and PM&R), I'll allow it to stay for now. (unless drusso wants to override?)

I understand that this is based on research coming out of LSU where you trained so you may have more insight into this technology and machine.

I was just alarmed by some of the contents on the neural scan website like:

"Reimbursable: One or two tests covers lease/purchase payment.
Disposable Cost: 50 cents per patient.
Earns More: Based on AMA Guideline sensory EDX is more appropriate and earns more per hour than MRI machines costing 100 times more."

"The Neural-Scan Nerve Conduction Study sensory (NCSs) exam is a simple painless test, your nurse can easily learn to perform in an hour."
Click to expand...


Let me hasten to point out

1) wscott is now a pain fellow at a Utah-based program

and

2) LSU Shreeveport is related to LSU-New Orleans as SUNY Stony Brook is related to SUNY Buffalo, which is to say, while both are funded by the government, they are separate and distinct insitutions, located at opposite ends of the state.
 
paz5559 said:
Let me hasten to point out

1) wscott is now a pain fellow at a Utah-based program

and

2) LSU Shreeveport is related to LSU-New Orleans as SUNY Stony Brook is related to SUNY Buffalo, which is to say, while both are funded by the government, they are separate and distinct insitutions, located at opposite ends of the state.
Click to expand...

Thanks paz5559, for jumping on that clarification.

Remember in my opening remarks the last thing I said was, "I'm very skeptical". In fact, I agree with most of the criticism, so far. My comments were directed for the benefit of generating feedback and I appreciate what's been said.

We should not be completely satisfied with the diagnostic tools we have at present, because inaccuracies in diagnosis are still made by superior clinicians. As such, clinicians looking to better serve patients should be open to consideration of new ideas. New technologies should be discussed, studied, and evaluated before they are discarded OR accepted, naturally. I suspect that's why it drew a lot of attention at the last ISIS meeting.

EITHER side of the fence will profit from winning their respective arguments (that's not rocket science, just business), so let’s take money out of the argument and take a hard look at the science. Remember Edison invented the light bulb to the dismay of the gas companies, and the world is better off.

Again, from what I have gathered, and what is obvious to me as well, is that the neural-scan does not have the potential to replace the well trained mind of a physiatrist or neurologist with interest in electrodiagnostics or the EMG/NCS studies they perform (for one it does not look at motor reponses at all). However, if it is validated in well designed studies, it could be an objective measure in sensory examination of A-delta fibers. That would be pretty cool and useful, in helping our COMPLETE evaluation point in a clearer direction towards the generating level of suspected radicular pain.

To be or not to be....objective evidence will answer.

P.S.
To the moderator - Sincerely, 1) thanks for your hard work and service to the community. and 2) Thanks for keeping the post in two different forums, because it has generated different discussion by different readers.

Have a great weekend everybody!!!
 
So I was on Rheumatology recently and we had a patient who said she had a "nerve test" for her footdrop. Turns out she had a portable NCS done by a family doc in town. The report cracked me up. RE: L5 radiculopathy vs peroneal neuropathy. Interpretation: probable L5 radiculopathy, cannot exclude peroneal peripheral neuropathy. Thanks. Way to waste money. We figured that out just on physical exam. The Rheumatologist said, "this is why I love having a physiatrist in the building."
 
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