[netchef]

There's a lot flying under the guise of 'Laboratories' these days and I believe I need to bring my experience to the notice of potential patients who could also be taken for a ride:
A couple of months ago I had undiagnosed stomach and urinary issues that had the Doctors at St John's Hospital in Bangalore baffled. All we knew was that blood tests revealed elevated liver function parameters as well as bilirubin in the urine. They asked me to have an Ultrasound done. Unfortunately, the Ultrasound lab at St John's was so busy they could only give me an appointment 5 days ahead; in my impatience I checked with my Dr if I could have this done at an external lab. Once I got their nod, I went to Apoorva Diagnostics in Indiranagar --a lab I had used in the past for blood tests etc.
In this situation--as a layman-- I assumed an ultrasound is an ultrasound. Boy was I wrong!
Firstly knowing that the elevated liver metrics indicated some problem there, I directed the technician about to do the Ultrasound to the issue/the area. He proceeded with the scan and his report indicated no issues AT ALL. I even asked him that if anything looked funky I was willing to go to the next level of tests such as an MRI or whatever but he insisted there were no problems.
I paid the bill of Rs 1500/ and showed the report to my docs at St John's who took it at face value and treated me accordingly.
Two weeks passed. My parameters were still beyond the envelope of normal and not coming under control. The entire panel of Docs from the Gastro department were puzzled. Fortunately for me they were suspicious and requested another ultrasound. This time I had it done in their own Ultrasound lab and guess what...it took 5 minutes for their technician to discover the apple-sized abscess on the liver.
From then on, the nature and intensity of their treatment changed dramatically. After a hospitalization and being administered a powerful cocktail of 'top gun' antibiotics, the abscess was brought under control, but the thing could easily have gone wrong because of an unprofessional lab and/or inept interpretation. Also, the ultrasound at St John's cost Rs 500/-

[DCEite]

Private ultrasound centers have more expertise in Maternity ultrasounds. Infact, if a male visits such shop, they can be confused at once. As their core competency is pregnancy related ultrasounds. That can explain their ineptness on interpreting Liver related issues on the Ultrasound.

Not all ultrasound centers are bad though. Go with a bigger brand and you'll be ok.

[aadya]

Originally Posted by netchef

There's a lot flying under the guise of 'Laboratories' these days and I believe I need to bring my experience to the notice of potential patients who could also be taken for a ride:
...

Not defending Apoorva. But it is not uncommon to see the findings not present in the first scan. Particularly this being an abscess it would have been too small to be detected, abscesses have been detected in CT scans within couple of days of a normal ultrasound scan. This is one of the reason investigations are usually done sometime after the symptoms appear so the changes are much more visible. This is a common perception nowadays that if we can afford an investigation we should it get it down prompto, might be counterproductive many of the times.

[deepak_misra]

Originally Posted by aadya

. This is a common perception nowadays that if we can afford an investigation we should it get it down prompto, might be counterproductive many of the times.

Further to what you say: Some time back, I had a lot of stomach pain and the doctor told me to do an ultrasound if the pain did not got away after 2 days. I asked him if I could do it the next day since it was a holiday for me. He did reproach me and told me that he prescribes test based on the need and not based on my convenience. SO he cannot ask me to do an ultrasound just because it is a holiday

[BLACKRiVAL]

Usually images are provided with ultrasound report. You can get that cross checked by another radiologist. Ultrasounds usually are not very accurate in fat patients and if the digestive system is gas filled as sound waves poorly penetrate gas/fat.

[Deep Blue]

Originally Posted by netchef

, I directed the technician about to do the Ultrasound to the issue/the area.
Two weeks passed. apple-sized abscess on the liver.

Two things here,
First, so far in India, ultrasound scans in India are not done by technicians. They are done by radiologists who are qualified doctors.
Second point, It is quite possible that in the first scan there was no abscess. Abscess is a collection of liquid pus due to bacterial infection of any tissue. It could have taken 2 weeks for the infected liver tissue to liquefy and form an abscess which was easily picked up by the second scan.

[Night Raven]

As a doctor I would say two things. Firstly the ultrasound is highly observer dependent. You actually need to have an idea what you are looking for to find it. That is where the experience and qualification of the person who does the scan comes in to play. I know at least a few major hospitals including teaching institutions where qualified technicians perform USG, but usually the radiologist takes over when it is a confusing case. Secondly as someone mentioned, the timing of the scan also is important. Liver enzymes will start getting released in to blood as soon as the inflammation starts in the liver tissue, but it will take sometime for that inflammation to create sufficient structural damage to the liver tissue to be picked up by the ultrasound. Again, a highly experienced radiologist with a clinical diagnosis in mind may have picked up the early changes that a confused technician who doesn’t know what he is dealing with might very well miss.
Wishing you a complete and speedy recovery from the abscess.

[ranjith_cbz]

May be the bigger lesson here is to stick to labs within hospitals for any critical or important or secondary investigations prescribed by Dr as they will be more attentive towards the reasons for which Dr has advised the test and can have the duty Radiologist readily available for when his expertise is necessary.

What i have seen in independent labs is that they are heavily dependent on trained technicians for multiple tests and tend to share one remote radiologist for signing off on the tests done at many of their labs.

[alpha1]

My layman observation is that ultrasound is not a general tool that can be used by anyone.
It is definitely NOT like taking an X-ray trusting that anyone else who is well versed can then read and decode based on the image.

The doctor operating the sonography apparatus has to be really proficient in real time to manouever the probe on your body to get the information that (s)he is seeking AND capture it properly in the image / report.

[Capri89]

Originally Posted by DCEite

Private ultrasound centers have more expertise in Maternity ultrasounds.

Really ?

I don't think so.

Some years back I did a scan for wife and the report said "uterus normal". Why it is funny ?

Because the scan was done post hysterectomy that was done few years earlier.

[green_ninja]

Originally Posted by netchef

Firstly knowing that the elevated liver metrics indicated some problem there, I directed the technician about to do the Ultrasound to the issue/the area.

Pardon my ignorance but why would you "direct" the technician to scan a certain area? Shouldn't the doctor have written a prescription describing the area to be scanned, so the technician knows what the doctor is looking for? Or am I missing something here?