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In this article for Becker's Orthopedic Review, Dr. Don A. Buford explains both the clinical evidence and benefits for the use of diagnostic ultrasound for shoulder evaluation. In particular, evidence for the use of ultrasound as the first imaging study in cases of suspected rotator cuff tear. Dr. Buford, an orthopedic surgeon, also covers the benefits of ultrasound to patients, his clinical practice and the costs to the healthcare system. As the healthcare system moves toward both Appropriate Use Criteria for imaging and lower costs, this article explains why it is time to implement such practices.

Healthcare Financial Management Association Blog
Paul R. Sierzenski, MD


The emerging healthcare environment requires expanded patient access while minimizing the cost of care. This is of particular importance for accountable care organizations that are assuming significant risk and must develop more innovative ways to deliver care to drive better outcomes and wring out inefficiencies. Our practice has experienced this struggle on a daily basis as patients, who needed a surgical consult, were frustrated with limited access. Our clinical schedule was filled with non-surgical candidates. This created a paradox where the most specialized health system resources (e.g., surgeon and MRI) were being allocated to a continuum of care that did not result in better care or outcomes, while also increasing physician and patient frustration. The long-standing dilemma was that the wrong patient was often in the wrong clinic leading to an inefficient and circuitous path for the delivery of appropriate care. When evaluating our practice it was clear that we could improve our allocation of available resources with the outcome being happy patients and happy physicians within a healthcare system that was delivering high quality, low cost, appropriate care.

Executive Insight
By Diku Mandavia, MD, FACEP, FRCPC

Yahoo! Health, Day in Health
By Lisa Collier Cool

Dr. Bahner underscores that since the 1980s, emergency ultrasound performed by emergency physicians at the point of care has been recognized as a valuable technology to improve the department.  Employing ultrasound at the bedside, he asserts, can reduce medical errors, provide more efficient real-time diagnosis, and in certain clinical scenarios, supplement or replace more expensive imaging modalities such as CT and reduce patient exposure to ionizing radiation.  This article details how ultrasound can improve procedural success and safety such as invasive procedures like nerve blocks and central venous catheter placement, prevent costly errors and discussed the future of emergency ultrasound which has grown since the American College of Emergency Physicians (ACEP) published its first specialty-specific ultrasound guidelines.

Patient Safety & Quality Healthcare
Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at Sonosite, and clinical associate professor of emergency medicine at the University of Southern California

True Value
David B. Case, MD, clinical associate professor of medicine at Cornell University Weill College of Medicine in New York 
John E. Postley, MD, FACP, assistant clinical professor of medicine at Columbia University.

This article enumerates the benefits and applications of Musculoskeletal Ultrasound and details procedural guidance for join and soft tissue injections and aspirations.  Dr. Goyal also explains that ultrasound technology has been shown to be 6.5 times more sensitive than x-rays for early, accurate diagnosis of small bone erosions in patients with rheumatoid arthritis.  He argues that point of care US can significantly reduce medical errors and offer efficient real-time diagnosis.   US can replace or supplement more expensive imaging technologies such as CT in appropriate clinical scenarios.