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ultra sound-Ellen

Posted by john h on 6/02/02 at 09:36 (086072)

Jan: I do not think they use ultrasound to find the point of pain but to located the insertions point of the fascia (may be wrong on this). I think the best way and the most used methond is by the doctor pressing on the foot until he/she finds the point of pain. They then mark it with a pen (dr z does this). I think the Epos is the only unit currently using ultrasound to point to where the shock waves will go.

Re: ultra sound-Ellen

Sunny Jacob - Bayshore on 6/02/02 at 10:07 (086075)

John,
just a small correction: At Bayshore we use Siemens Sonocur for multiple treatment,low energy ESWT. We always followed the European procedure of using in-line ultrasound to direct shock wave. Most equipments manufactured in Europe, including Dornier Epos, have ultrasound imaging component as part of the ESWT equipment.
However, in North America many clinics do not purchase this feature because of the high cost and the required expertise in ultrasound image diagnosis.

Re: ultra sound-Ellen

DR Zuckerman on 6/02/02 at 13:13 (086086)

Location of the orgin of the problem is by palpation, examination and confirmed with ultrasound. What makes Ultrsound so great is when deliving the shockwave treatment you are able to control the exact location.

Most feet and the origin of pain move during the treatment .Ulrasound allows the treating doctor ot see the movement and make the correction during the treatment. Its just plain simple you see exactly where the shockwave should go and see where they are going

Re: ultra sound-Ellen

john h on 6/02/02 at 13:48 (086092)

thanks sunny. do you use finger pressure to locate the tender spot?

Re: ultra sound-Ellen

Sunny Jacob - Bayshore on 6/03/02 at 05:41 (086124)

We direct the patient using finger pressure to locate the area where there is maximum pain and mark the point. Then we examine this area with the portable ultrasound transducer. Following this, the shockwave head with the inline ultrasound transducer is locked to the point using the hairline cross. If the patient moves during the treatment the shockwave head position has to be maintained at the pain location by using the hairline cross on the ultrasound screen.

Re: ultra sound-Ellen

john h on 6/03/02 at 09:40 (086139)

That makes sense to me Sunny. Since the focal point of the shockwave is so narrow and the patients foot is not locked in a movement free enviroment it would be easy to miss the target if the patient moved just an inch or so. How is Dr. Gordon's study progressing?

Re: ultra sound-Ellen

Ed Davis on 6/03/02 at 15:20 (086163)

Sunny:

You may be amazed at how rapidly the price of diagnostic ultrasound units has dropped in the last 3 years. If interested, an independent unit could be purchased at a reasonable cost.

That being said, I do not feel that 'aiming' is an issue at this time, particularly with plantar fasciitis. See my prior post. I feel that that an artificial issue is being created for marketing purposes but we need to put that in perspective.
Ed

Re: keeping the foot steady

BrianG on 6/03/02 at 15:36 (086168)

While I was having my ESWT treatment, the doctors had to hold my foot in the correct position, by hand. I'm wondering why no one has come up with a block method, to keep the foot steady, like in an MRI machine. Should I get a patent, and make my 1st million? :*)

BrianG

Re: ultra sound-Ellen

DR Zuckerman on 6/03/02 at 21:29 (086205)

I use to think that ultrasound wasn't important in the ESWT treatment. That was until I started to use the dornier machine and its ability to place pulses in all areas of insertional plantar fasciitis. This is something that has changed my level of care.

With the ossatron you must use IV sedation due to the plantar approach. With the dornier you can go from the side avoid the bone and get the exact level of energy . This can only be done with inline ultrsoune imaging

Re: ultra sound-Ellen

Ed Davis, DPM on 6/04/02 at 18:59 (086297)

The PF is relatively superficial and easily identifiable so do you feel that you could not find the same areas to aim at without the help of ultrasound?
Ed

Re: ultra sound-Ellen

Sunny Jacob - Bayshore on 6/02/02 at 10:07 (086075)

John,
just a small correction: At Bayshore we use Siemens Sonocur for multiple treatment,low energy ESWT. We always followed the European procedure of using in-line ultrasound to direct shock wave. Most equipments manufactured in Europe, including Dornier Epos, have ultrasound imaging component as part of the ESWT equipment.
However, in North America many clinics do not purchase this feature because of the high cost and the required expertise in ultrasound image diagnosis.

Re: ultra sound-Ellen

DR Zuckerman on 6/02/02 at 13:13 (086086)

Location of the orgin of the problem is by palpation, examination and confirmed with ultrasound. What makes Ultrsound so great is when deliving the shockwave treatment you are able to control the exact location.

Most feet and the origin of pain move during the treatment .Ulrasound allows the treating doctor ot see the movement and make the correction during the treatment. Its just plain simple you see exactly where the shockwave should go and see where they are going

Re: ultra sound-Ellen

john h on 6/02/02 at 13:48 (086092)

thanks sunny. do you use finger pressure to locate the tender spot?

Re: ultra sound-Ellen

Sunny Jacob - Bayshore on 6/03/02 at 05:41 (086124)

We direct the patient using finger pressure to locate the area where there is maximum pain and mark the point. Then we examine this area with the portable ultrasound transducer. Following this, the shockwave head with the inline ultrasound transducer is locked to the point using the hairline cross. If the patient moves during the treatment the shockwave head position has to be maintained at the pain location by using the hairline cross on the ultrasound screen.

Re: ultra sound-Ellen

john h on 6/03/02 at 09:40 (086139)

That makes sense to me Sunny. Since the focal point of the shockwave is so narrow and the patients foot is not locked in a movement free enviroment it would be easy to miss the target if the patient moved just an inch or so. How is Dr. Gordon's study progressing?

Re: ultra sound-Ellen

Ed Davis on 6/03/02 at 15:20 (086163)

Sunny:

You may be amazed at how rapidly the price of diagnostic ultrasound units has dropped in the last 3 years. If interested, an independent unit could be purchased at a reasonable cost.

That being said, I do not feel that 'aiming' is an issue at this time, particularly with plantar fasciitis. See my prior post. I feel that that an artificial issue is being created for marketing purposes but we need to put that in perspective.
Ed

Re: keeping the foot steady

BrianG on 6/03/02 at 15:36 (086168)

While I was having my ESWT treatment, the doctors had to hold my foot in the correct position, by hand. I'm wondering why no one has come up with a block method, to keep the foot steady, like in an MRI machine. Should I get a patent, and make my 1st million? :*)

BrianG

Re: ultra sound-Ellen

DR Zuckerman on 6/03/02 at 21:29 (086205)

I use to think that ultrasound wasn't important in the ESWT treatment. That was until I started to use the dornier machine and its ability to place pulses in all areas of insertional plantar fasciitis. This is something that has changed my level of care.

With the ossatron you must use IV sedation due to the plantar approach. With the dornier you can go from the side avoid the bone and get the exact level of energy . This can only be done with inline ultrsoune imaging

Re: ultra sound-Ellen

Ed Davis, DPM on 6/04/02 at 18:59 (086297)

The PF is relatively superficial and easily identifiable so do you feel that you could not find the same areas to aim at without the help of ultrasound?
Ed