What is a focused protocol?

Ultrasound – and particularly portable ultrasound – is transforming the world. It’s arguably the most rapidly evolving imaging technology we have.

The observation that it is becoming more and more affordable and accessible is in no way unique to dog pregnancy scanning. It’s a challenge – or an opportunity – that is being played out across a number of fields.

Professionals have been fighting this pressure for many years, feeling that as ultrasound falls into the hands of more and more people, their niche is being threatened. In the veterinary world, it’s a fear that was initially felt by veterinarians, and now more recently, by experienced lay scanners. However, with every new challenge comes opportunity, and this is something that professional bodies and associations are beginning to realise and embrace.

In this article, we will look at focused ultrasound. This is something that is not applicable to veterinarians (who, when scanning, are performing a full diagnostic examination), and equally, not possible for inexperienced lay scanners. It’s an opportunity that can only be explored by experienced scanners, who are by now very comfortable performing scans and optimising their images, and are looking for another outlet for their skills and grow their scanning business.

What is a focused scan?
In one way, a focused protocol, performed by somebody without medical training, is a little bit like a professional wedding photographer and her assistant. The assistant’s job is to obtain a few important, standard pictures that she takes in exactly the same way, every single time (i.e. the group shots – arranging the family in a conventional fashion). The lead photographer will put all of those together with her own creative shots, the ones which are tailored specifically for that wedding, and come up with a finished product that she takes full responsibility for.
It’s not the assistant’s job to go off-piste and try her hand at being the lead wedding photographer. She has to be relied upon to follow the protocol and obtain the set checklist of photographs.

This is the essence of a focused scanning protocol. The person performing the protocol does not need to be a veterinarian, a cardiologist or a reproductive specialist performing an in-depth investigation – they need to be an excellent technician. They need to have the dexterity to manipulate their transducer, and the knowledge to adjust their scanner controls, to obtain and optimise their images. These images can then be interpreted by the veterinarian, whether or not they can scan themselves.

Example
The below video demonstrates one major pathology that can be spotted relatively easily. If you’ve only performed pregnancy scans to date, this cardiac example will look very alien. That is, in fact, the entire concept; one does not need to learn canine or feline cardiology (this is the domain of the vets), but the practical skills involved in acquiring a few key images, and as somebody who has been working with ultrasound for possibly many years already, you’re already most of the way there.

Practical implication

The scientific literature is rapidly filling with studies showing the success of portable ultrasound in the hands of non-sonographers (provided these images are interpreted by an expert). Many vet practices do not have the resources to invest in purchasing their own ultrasound machine, nor the time to learn how to use it properly. As anyone who has persevered in learning small animal pregnancy scanning will know, the learning curve is a steep one, and it takes tens if not hundreds of scans to become proficient. When you’re already consulting and performing surgery all day, it’s difficult to see how small vet practices can afford to make this kind of time investment.

If you already have a close working relationship with your local practice, it may be worth asking them if they would be interested in you using your equipment to capture certain key images with them. The more forward-thinking practices may be willing to consider the idea, given that, on the cardiac side for example, referral to a cardiologist or veterinary echocardiographer will cost the practice hundreds of pounds, as well as involving a waiting time – time the animal may not have.

The future

Focused scanning protocols, performed on portable ultrasound equipment, are the future. It may well be too much too soon for the veterinary world, but in human medicine, the concept is already gaining traction. It is well worth keeping in mind as a potential avenue for development of your own skills, and of your business. It is a role that DEFRA-approved cattle scanners are already fulfilling to a certain degree, working closely with vet practices to screen the herd and refer non-pregnant cows for veterinary attention in order to get them cycling faster than they would if the farmer had to wait for the scheduled vet visit, catching potential pyometra early, and so on. In the long run, it actually improves the profitability of vet practices, allowing them to focus their time on more specialist procedures, for which they can of course charge higher rates.

Of course, these cattle scanners are able to perform these types of scans independently, having gained a qualification that grants them the legal ability to do so – but what this demonstrates is that, for those who have worked to build relationships of trust between themselves and veterinary practices, performing a screening role is very much complimentary to the work of the qualified veterinarian.

Taking the next step

If you are interested in this concept and have a veterinary practice with whom you can implement it, please get in touch for help designing and performing a focused protocol: contact@animalultrasoundassociation.org

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