John S. Reach Jr., MD, director of the Yale Foot and Ankle Service and assistant professor of orthopaedic surgery for Yale School of Medicine, is using a new approach to identify, detect and treat musculoskeletal disorders through ultrasonography. Dr. Reach has pioneered the use of hand-held, portable, surgeon-used ultrasound to help diagnose patients at their initial surgical consultation.
"Ultrasound — which is very familiar to pregnant women — is rapid, uses no radiation and can be delivered at the point of care by the treating surgeon," explained Dr. Reach. "It can reduce the need for expensive, time-consuming tests and return visits by the patient. A process that used to take days or weeks is now accomplished in less than 10 minutes."
A series of studies led by Dr. Reach examined the use, training, outcomes and accuracy of surgeon-held musculoskeletal ultrasound at Yale School of Medicine and Duke Medical School. Researchers found appropriately trained orthopaedic surgeons can reduce overall time to patient diagnosis, enhance subjective and objective clinical outcomes, and significantly lower some out-of-pocket expense for patients. Results of the studies were presented at the 2008 American Academy of Orthopaedic Surgeons (AAOS) and American Institute of Ultrasound Medicine (AIUM) annual meetings.
"Ultrasound allows surgeons to see structures hidden by the patient's skin at the initial time of consultation," said Dr. Reach. The ultraportable laptop-like scanner used by Dr. Reach was developed in part by the Defense Advance Research Projects Agency (DARPA) and can be easily carried from office to operating room. "In the treating surgeon's hands, this imaging produces accurate diagnostic results that can be immediately acted upon by the surgery team in the operating room."
Dr. Reach has been instrumental in making YNHH a leader in musculoskeletal ultrasound (MU). Last fall, he reported his research to Congress. In late February 2009, he chaired a musculoskeletal ultrasound symposium at the American Academy of Orthopaedic Surgeons in Las Vegas. He is working with graduate and medical schools to incorporate musculoskeletal ultrasound into training curriculums and is the director of the Yale Musculoskeletal Ultrasound Fellowship which helps practicing surgeons learn proper indications and techniques of this operator dependent imaging modality.
"Rapid, efficient and powerful imaging allows orthopaedic surgeons to improve patient care and decrease overall health costs," said Dr. Reach. "Each day, I share my patients' amazement when we identify their exact area of discomfort and immediately look beneath the skin and confirm the diagnosis using images of their own anatomy. This way, we can outline a personalized surgical plan of care during the same visit. We also use this same technology in the OR prior to surgery so the entire team can see what is beneath the skin in real time."
"Orthopedic surgeons are in an ideal place to perfect musculoskeletal ultrasound use," concluded Dr. Reach. "Surgeons know the anatomy, and can directly verify accuracy of diagnosis in the operating theater."