The AMUS Quiet Healthcare Revolution

I believe in the future of our healthcare system and I believe that many changes are on the horizon. I think the system will strive to find new ways to save money while delivering the best possible care. This is by no means an easy feat. I do not know what the global answers will be but I plan to ride the wave. I do believe that part of it lies in medical imaging and truly believe we can do a better job for the patient while saving them, and the system as a whole, money. I believe in the AIUM's initiative to think "ultrasound first." Too many imaging needs are being sent directly to advanced imaging modalities. The first thought of any imaging need should not be MRI or CT. It should be X-ray or Ultrasound, in fact unless it is strictly a boney concern, then it should be ultrasound first. Remember ultrasound uses no harmful ionizing radiation, no nephrotoxic contrast agents, and no claustrophobia inducing apparatuses. It is quick, safe, effective, less costly and - in the right hands - more accurate than MRI and even MRA for MSK applications such as rotator cuff tears. Help AMUS and the AIUM to convince the healthcare world to think "Ultrasound First." 

Telemedicine meets Home Health

When I originally began this company, I wanted to find a way to bring ultrasound to people of the community. I was tired of seeing long wait times, back logged and over worked sonographers, over exposoure to radiation and frightened, frustrated patients. This idea manifested into  patnerships with teleradiology and telecardiology groups that I contracted with to view and interpret my studies. From this. A+ Mobile Ultrasound Services was born partly as an independent imaging center, but also a telemedicine facility in that physicians do not have to be present to interpret the exam. With the the high resloution of portable machines and the quality of still images and cineloop video clips, I can securely transmit all the data from my machine to a cloud based reading station where radiologists and cardiologists vew and interpret results. This system has proven to work beautifully with turn around times as short as 20 minutes. Although this system works well, it has many logistic issues around scheduling that prove challenging. For this reason we are persuing a home health license through the Washington State Department of Health. We would become the first Home Health Agency for diagnsotic medical imaging in the state and will be able to schedule exams at a time that makes sense for the patient. This will free up referring physicians' time and exam rooms. We look forward to this transition of telemedicine and home health merger and will update with progress. 

Chronic musculoskeletal pain increases CVD risk

Chronic musculoskeletal pain increases CVD risk

By Lucy Piper, Senior medwireNews Reporter

06 January 2014

Eur J Pain 2013; Advance online publication

medwireNews: Chronic musculoskeletal pain (CMP) is associated with an increased risk for cardiovascular disease (CVD), researchers have found.

They note that this association was particularly strong in adults older than 65 years with CMP, who were 1.83 times more likely than those without CMP to have CVD after taking into account a range of CVD risk factors. Also, the association could not be explained by reduced physical activity or increased sedentary behavior.

Rather, the team suggests that physiologic or psychosocial effects of pain, such as obesity, stress, and increased levels of pro-inflammatory cytokines, may be involved.

“Clinically, this study suggests the intriguing implication that CMP may be a modifiable risk factor for CVD,” note the researchers, led by Cormac Ryan (Teeside University, Middlesborough, UK).

“Considering, on average, 10% of the world’s population report CMP… this could have far reaching implications for CVD prevention giving support to previous calls for CMP to be considered as a public health priority.”

Among 3332 middle-aged (45–64 years) and 2022 older adults, who participated in the Health Survey for England (2008), 18% and 28%, respectively, reported having CMP. And of these individuals, 22.5% and 46.8% had CVD. This compared with a corresponding 13.5% and 28.2% of participants without CMP.

Logistic regression analysis showed that middle-aged adults with CMP were more likely to have CVD than those without, at an odds ratio of 1.27 after taking into account CVD risk factors, such as body mass index, metabolic conditions, and alcohol intake, but unlike in older adults it did not reach statistical significance.

Self-reported, but not objectively measured, physical activity was independently associated with CVD in both middle-aged and older adults. But neither subjectively nor objectively measured physical activity contributed meaningfully to the association between CMP and CVD.

Similarly, while subjectively and objectively measured sedentary behavior was an important risk factor for CVD in older adults, it did not contribute to the association between CMP and CVD in these individuals.

Ryan et al note in the European Journal of Pain that the cross-sectional design of the 2008 Health Survey for England meant that causality and the direction of the relationship between CMP and CVD could not be confirmed.

But they conclude: “If our findings are supported by future large longitudinal studies, this would suggest that the appropriate management of CMP should not simply be viewed as an intervention for CMP in itself but also a preventive… strategy to reduce the risk of developing CVD.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

Musculoskeletal (MSK) Ultrasound

MSK ultrasound is a new modality in our geographic area for imaging soft tissue around joints. It usues high frequency sound waves to generate an image using an ultrasound machine. There is no radiation or contrast needed. There is no claustrophobic apparatus and with the portability of today's ultrasound machines, they can be performed just about anywhere - including normal exam rooms, in the patient's home or even on the sports field. MSK is especially useful in sports injury - both for diagnosing abnormalites (tears, strains, sprains) as well as monitoring recovery.  Some of the most common uses include rotator cuff tears and abnormailites, carpal tunnel syndrome, tennis elbow, runners and jumpers knee, ankle sprains, snapping hip syndrome, effusions and tendinitis. Much recent literature has been produced showing the benefots and even better acuracy of MSK ultrasound over MRI.