COSM13: Technological Advances Expand Range of Office-Based Otolaryngology Procedures

“There are a lot of arguments in favor of point-of-care imaging,” from earlier diagnosis, to convenience, to avoiding delays in scheduling, and earlier diagnosis means patients can avoid taking antibiotics or steroids during that period, Dr. Senior said.

The American Academy of Otolaryngology-Head and Neck Surgery, he pointed out, came out solidly in favor of in-office CT imaging in 2010 with a physician statement. But, the American College of Radiology has raised concerns about self-referral; a report several years ago found that during a five-year period at the beginning of the last decade, the CT volume in private offices owned by radiologists increased by 85 percent—but rose 263 percent for non-radiologists. Further, the former director of the White House Office of Management and Budget, Peter Orszag, said in 2009 that 20 to 50 percent of CT, MR and PET procedures were unnecessary.

Dr. Senior said concerns about increasing exposure to radiation are warranted. FDA data he presented shows that it would take from two days to more than two years of natural exposure to absorb the amount of radiation from CT procedures, depending on the procedure type. He suggested the use of thyroid collars, which he said can reduce the effective dose by 40 percent.

David Steward, MD, professor and director of thyroid/parathyroid disorders at the University of Cincinnati, said ultrasound is best for imaging of thyroid nodules. “Ultrasound has become the workhorse of thyroid patients,” he said. “It’s very convenient for the patient to come into the office … see the physician and get the imaging and diagnostic or therapeutic procedure done at the same time. And that does help with your practice building.”

It is useful for parathyroid, salivary gland, lymph node and neck mass imaging, Dr. Steward said. Ultrasound equipment is “maybe an order of magnitude less” than CT scanners but is “not inexpensive” at about $35,000 but “one can usually recoup that cost over a one- to three-year period depending on the volume,” he said. Dr. Steward noted that although it does add time to the office visit, a thyroid ultrasound is fairly quick and straightforward, taking less than five minutes.

Laser Procedures

Ivan Wayne, MD, assistant professor of facial plastic and reconstructive surgery at the University of Oklahoma in Oklahoma City, said that when considering adding aesthetic laser equipment to your office practice, it’s best to rent it first. “Make sure that it’s something you like to do or your staff likes to do, and that you can actually make money at it,” he said. Physicians should also be aware of who can run the equipment. Oklahoma regulations allow anyone to run it, under his supervision, but rules vary from state to state.