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Difference in ESWT machines

Posted by Sunny Jacob, Bayshore on 9/07/02 at 09:45 (094680)

When scientific studies and data are readily available, opinions are just opinions.
Based on recent message board opinions, can one use maximum energy level on Dornier without I.V. or local anesthesia?
What is a 'production of shockwave'?
What is 'more effective'? In relation to what?

In-line ultrasound is an integrated part of most of the ESWT equipments. However, the FDA studies used ultrasound imaging for one study only (Dornier) and did not use it for Sonocur or Ossatron.

My 'opinion': If one uses in-line ultrasound with the equipment of a reputable manufacturer, the ESWT treatment outcome (in percentage) can be substantially better than when treatment is done without the use of in-line ultrasound imaging.
Secondly, multiple session low energy treatment has a better outcome than single session treatment. Almost all ESWT equipments with electromagnetic shockwave heads (including Dornier, Epos) are designed for multiple sessions for all countries. However, in the United States, Dornier is being used for single treatment. Of course, multiple treatment sessions require 3 times more time for the patient and the clinic. Without the aid of in-line ultrasound focusing, it is difficult to judge the depth, i.e. the focal point could be on the bone rather than the intended fascia.

My opinion is based on documented results Bayshore patients of the past four years.
All European treatment protocols do include the use of in line ultrasound and multiple session treatment.
In the U.S., the trend seems to be to save 75% of treatment time, saving component cost and developing a new treatment protocol. What is the point of ‘saving' when the patients are already paying rather high fees?
We successfully treat U.S. patients in our clinics who had previous ESWT in several U.S. locations at high cost and unsatisfactory outcome.

Re: Difference in ESWT machines

Dr. Z on 9/07/02 at 10:40 (094683)

I will try to comment if I can from what I know because some of the comment are from different messages from all over the board.
I am not sure what the first paragraph is saying. Scientific Studies are much more accepted then personal opinions. Don't you agree

We can't determine which is better single or multiple ESWT session. However if you used the Roles Maundsley pain evaluation and or the VAS with a one year study follow up at mulitple site then we can compare apples to apples

I like inline ultrasound. Is there somewhere where I state I don't . This is my personal opinion. as well as your

The last point I don't understand . We treat patients from the USA that had high cost ESWT treatment. The reverse can be stated also. I am sure there are ESWT sites in the USA where low energy ESWT was used
and failed and then USA high energy was used and cured. There are cases from the web site where this happened It going to happen and it proves nothing yet

The fact that dornier was the only company to use inline ultrasound when other companies such as soncur, and ossatron was the choice of the companies and not the FDA

Does your ossatron machine in your clinic use inline ultrasound ?

Actually what the point . We agree on alot of points and will have a difference of opinion. What I would like to do is open up a dialogue of result comparison using an agreed upon method of evaluation

I will love to have Scott Roberts again starting to post these results. .

What do you say . Would be very helpful to the many many posters on heelspurs.com

Re: Difference in ESWT machines

Dr. Z on 9/07/02 at 15:26 (094708)

You need a local anesthesia when using high energy with the dornier epos as well as with other high energy treatment

I think the term production of a shockwave is from either an electromagnetic, or sparkgap discussion Was that the topic of discussion. Did I say that the electro magnetic method is better then sparkgap. From my experience and from my discussion with engineers the electromagnetic is a better method a a method for ESWT treatment

Is this what you say is misleading . Please I really want to understand exactly what you are talking about

Re: Difference in ESWT machines

Carmen H on 9/09/02 at 08:17 (094804)

So a local Anesthetic IS used for the Dornier Epos????
Is this the same as a twilight sleep?

My Pod here says the Dornier is not as effective as the Healthtronics Ossatron.
Is this true?

Re: Technical correction

Scott D. on 9/09/02 at 09:49 (094811)

The term 'in-line' ultrasound implies that the transducer looks along the same line as the path of the shock waves. We use an in-line ultrasound system in our Storz kidney lithotripter. The Dornier EPOS, which we use for ESWT, has an 'out-line' ultrasound system because it looks through a window other than the path the shock waves travel. Not that it makes a big difference, just clearing up the proper terminology.

Re: Difference in ESWT machines

Ed Davis, DPM on 9/09/02 at 17:48 (094845)

All good observations. It will probably take a while before enough data is out there to answer the questions with more certainty.

Depth is not something that is readily selectable. The shock wave is absorbed and attentuated by the tissue in front of the target. The thicker or denser the tissue, the more attentuation to a large extent although the elasticity of tissues should allow some recoil of energy applied. The bone beneath the fascia will always absorb some energy, more with higher powered machines. The intensity of the shock wave will determine depth as opposed to the 'aim' of the machine. The focal point is pre-determined.
Ed

Re: Difference in ESWT machines

Dr. Z on 9/09/02 at 19:56 (094858)

Yes a local anesthetic is use. The dornier according to the FDA studies is more effective then the ossatron. I have no idea why your pod would say this to you

Re: Difference in ESWT machines

Carmen H on 9/09/02 at 20:00 (094860)

But is it the same as the twilight sleep?

Re: Difference in ESWT machines

Dr. Z on 9/09/02 at 20:15 (094861)

No. Twilight sleep is where an IV is placed into your arm view and IV medication is use to make you not feel the foot Local is where the anesthetic is placed into the foot to make it numbe like the dentist

Re: Technical correction

Sunny Jacob, Bayshore on 9/10/02 at 07:05 (094879)

I was under the impression that the Dornier Epos sold in U.S.A. uses in-line ultrasound. The Siemens Sonocur Plus we use has in-line ultrasound imaging, i.e. transducer aims and locks along the same line as the path of the shock waves.

Re: Technical correction

Scott D. on 9/10/02 at 07:49 (094887)

The typical configuration of the EPOS during treament is that the therapy head is against the medial edge of the foot and the ultrasound tranducer is along the plantar aspect.

Re: Difference in ESWT machines

john h on 9/10/02 at 11:44 (094907)

Carmen: My non scientific thoughts are that the individual and his/her particular problem and cause have as much to do with effective treatment with ESWT as the machine. Also much will have to do with what ever machine is used hitting the problem area in your foot as the focal point of all the machines is very narrow and if you cannot identify where your pain generator is located you could very easily be treating the wrong area. I am very much a believer in ESWT and still plan on further treatment hopefull before the end of this year. I know all the manufacturers have their pluses and minues for their equipment and we as consumers must weigh what information is out there in selecting a Doctor and the treatment protocol.

Re: Difference in ESWT machines

john h on 9/11/02 at 17:14 (095054)

I do not think that 'twilight sleep' can be defined in strict medical terminology. I bet some of you 60's crowd have been in many a twilight sleep.

Re: Difference in ESWT machines

Dr. Z on 9/07/02 at 10:40 (094683)

I will try to comment if I can from what I know because some of the comment are from different messages from all over the board.
I am not sure what the first paragraph is saying. Scientific Studies are much more accepted then personal opinions. Don't you agree

We can't determine which is better single or multiple ESWT session. However if you used the Roles Maundsley pain evaluation and or the VAS with a one year study follow up at mulitple site then we can compare apples to apples

I like inline ultrasound. Is there somewhere where I state I don't . This is my personal opinion. as well as your

The last point I don't understand . We treat patients from the USA that had high cost ESWT treatment. The reverse can be stated also. I am sure there are ESWT sites in the USA where low energy ESWT was used
and failed and then USA high energy was used and cured. There are cases from the web site where this happened It going to happen and it proves nothing yet

The fact that dornier was the only company to use inline ultrasound when other companies such as soncur, and ossatron was the choice of the companies and not the FDA

Does your ossatron machine in your clinic use inline ultrasound ?

Actually what the point . We agree on alot of points and will have a difference of opinion. What I would like to do is open up a dialogue of result comparison using an agreed upon method of evaluation

I will love to have Scott Roberts again starting to post these results. .

What do you say . Would be very helpful to the many many posters on heelspurs.com

Re: Difference in ESWT machines

Dr. Z on 9/07/02 at 15:26 (094708)

You need a local anesthesia when using high energy with the dornier epos as well as with other high energy treatment

I think the term production of a shockwave is from either an electromagnetic, or sparkgap discussion Was that the topic of discussion. Did I say that the electro magnetic method is better then sparkgap. From my experience and from my discussion with engineers the electromagnetic is a better method a a method for ESWT treatment

Is this what you say is misleading . Please I really want to understand exactly what you are talking about

Re: Difference in ESWT machines

Carmen H on 9/09/02 at 08:17 (094804)

So a local Anesthetic IS used for the Dornier Epos????
Is this the same as a twilight sleep?

My Pod here says the Dornier is not as effective as the Healthtronics Ossatron.
Is this true?

Re: Technical correction

Scott D. on 9/09/02 at 09:49 (094811)

The term 'in-line' ultrasound implies that the transducer looks along the same line as the path of the shock waves. We use an in-line ultrasound system in our Storz kidney lithotripter. The Dornier EPOS, which we use for ESWT, has an 'out-line' ultrasound system because it looks through a window other than the path the shock waves travel. Not that it makes a big difference, just clearing up the proper terminology.

Re: Difference in ESWT machines

Ed Davis, DPM on 9/09/02 at 17:48 (094845)

All good observations. It will probably take a while before enough data is out there to answer the questions with more certainty.

Depth is not something that is readily selectable. The shock wave is absorbed and attentuated by the tissue in front of the target. The thicker or denser the tissue, the more attentuation to a large extent although the elasticity of tissues should allow some recoil of energy applied. The bone beneath the fascia will always absorb some energy, more with higher powered machines. The intensity of the shock wave will determine depth as opposed to the 'aim' of the machine. The focal point is pre-determined.
Ed

Re: Difference in ESWT machines

Dr. Z on 9/09/02 at 19:56 (094858)

Yes a local anesthetic is use. The dornier according to the FDA studies is more effective then the ossatron. I have no idea why your pod would say this to you

Re: Difference in ESWT machines

Carmen H on 9/09/02 at 20:00 (094860)

But is it the same as the twilight sleep?

Re: Difference in ESWT machines

Dr. Z on 9/09/02 at 20:15 (094861)

No. Twilight sleep is where an IV is placed into your arm view and IV medication is use to make you not feel the foot Local is where the anesthetic is placed into the foot to make it numbe like the dentist

Re: Technical correction

Sunny Jacob, Bayshore on 9/10/02 at 07:05 (094879)

I was under the impression that the Dornier Epos sold in U.S.A. uses in-line ultrasound. The Siemens Sonocur Plus we use has in-line ultrasound imaging, i.e. transducer aims and locks along the same line as the path of the shock waves.

Re: Technical correction

Scott D. on 9/10/02 at 07:49 (094887)

The typical configuration of the EPOS during treament is that the therapy head is against the medial edge of the foot and the ultrasound tranducer is along the plantar aspect.

Re: Difference in ESWT machines

john h on 9/10/02 at 11:44 (094907)

Carmen: My non scientific thoughts are that the individual and his/her particular problem and cause have as much to do with effective treatment with ESWT as the machine. Also much will have to do with what ever machine is used hitting the problem area in your foot as the focal point of all the machines is very narrow and if you cannot identify where your pain generator is located you could very easily be treating the wrong area. I am very much a believer in ESWT and still plan on further treatment hopefull before the end of this year. I know all the manufacturers have their pluses and minues for their equipment and we as consumers must weigh what information is out there in selecting a Doctor and the treatment protocol.

Re: Difference in ESWT machines

john h on 9/11/02 at 17:14 (095054)

I do not think that 'twilight sleep' can be defined in strict medical terminology. I bet some of you 60's crowd have been in many a twilight sleep.