The benefits of doing ultrasound exams in your office
Family medicine ultrasound is more accurate, more cost-effective, and less time-consuming than you might imagine. Here’s how it can improve your care.
Most importantly, research has demonstrated that long-term mortality benefits are associated with ultrasound screening of asymptomatic patients for AAA. For example, one study found that screening asymptomatic men ages 65 to 74 (a population-based sample, with no particular risk factors) for AAA resulted in a reduction in all-cause mortality and that the benefit of AAA-related mortality continued to accumulate throughout follow-up.12
In fact, nationwide programs to screen for AAA using ultrasound have been established in England, Northern Ireland, Scotland, Sweden, the United States, and Wales to help prevent deaths associated with AAA rupture.13 Despite the documented benefits of ultrasound screening for AAA, a large retrospective cohort study conducted in an American integrated health care system found that only about 9% of patients eligible for screening according to USPSTF guidelines were screened for AAA with ultrasound in primary care practices in 2012.14
While most AAA screening occurs in the hospital, screening for the condition can be just as easily and effectively performed in an FP’s office or outpatient clinic. A Canadian prospective observational study demonstrated that aortic diameter measurements were comparable whether they were obtained by ultrasound performed by an office-based physician (who had completed an emergency ultrasonography course and performed at least 50 ultrasonographer-supervised ultrasound scans of the aorta), or by a hospital-based technologist whose scans were then reviewed by a radiologist.15 (See the TABLE for an overview of the research involving family medicine ultrasound.)
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The office-based scans had a high degree of correlation (0.81) with the hospital-based ones, a sensitivity and specificity of 100%, and lasted a mean of 3.5 minutes. The researchers concluded that ultrasound screening for AAA can be safely performed in the office setting by FPs who are trained to use point-of-care ultrasound technology, and that the screening can be completed within the time constraints of a typical family practice office visit.15
In a separate study, cardiologists compared hand-held ultrasound screening for AAA to standard 2-dimensional echocardiography. This study found that screening for AAA in an outpatient clinic with a hand-held ultrasound device is feasible and accurate with a sensitivity of 88% and a specificity of 98%.16
