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the left side, looking at real-time images of the two main arteries sending oxygenated blood to my brain.
I turned 35 the day before this test. That was important to know, because the data from this CIMT study is thought to be most useful when compared against other white men in my age bracket.
Watching my carotids on the screen didn’t offer up any surprises. I run four miles a day, and bike an average of six to eight miles a day when I’m home in Seattle. My arteries looked wide open on the ultrasound screen.
But that wasn’t the last word, because this test takes quantitative measurements of arterial thickness that you can’t see with the naked eye. Sure enough, there was zero plaque buildup in my arteries, and the arterial wall thickness was about what is expected of a 28-year-old man. (For any primary care docs or cardiologists in the audience, if you want to interpret my report for free, click here.)
Mainly, Hall says, the SonoSite test will be used by primary care physicians with an emphasis on preventive medicine. SonoSite says about 100 of these CIMT software upgrades have been sold to doctors, but that it doesn’t really know how many patients have gotten this same exam. There are about 134,000 primary care physicians in the U.S., and about 24,000 cardiologists who might be interested in using an ultrasound CIMT test to track progress of their patients over time. Most cardiologists treat sick patients, rather than try to keep healthy patients from getting sick, so it’s hard to see exactly why they’d want this tool for prevention.
I didn’t get a hard number on what the test actually costs per patient, but it would have to factor in the physician’s time, the cost of a SonoSite ultrasound machine ($24,000 to $40,000), the $4,000 for the initial software license and $2,500 for additional licenses, and the cost of running the medical practice, according to David Levesque, SonoSite’s vice president of market development for cardiovascular disease management.
For that cost, what’s the benefit? This is something health economists could spend years trying to answer through following patients after CIMT exams, and following up on whether they changed their behavior and actually lowered their risk of heart attack. But SonoSite is going to pitch it for the time being on the potential for savings to the healthcare system—kind of an important concept in the era of healthcare reform.
“We believe it has great potential as medicine becomes more focused on prevention as a means of reducing morbidity, mortality, and end stage disease treatment,” Levesque says. “The cost-benefit ratio for CIMT versus heart catheterization, CT, and/or MRI is significantly better for everyone involved.”
When I followed up after my test with Goodwin, SonoSite’s CEO, he didn’t really say how much of an earnings driver this sort of test could be for the company, or how widely it could catch on in primary care medicine. He wanted to talk about lots of other applications for ultrasound, which are probably worth stories for another day. But the main theme, of using ultrasound images for preventive medicine, is certainly a big idea, and CIMT tests are just one component. Essentially, it’s one thing when your doctor lectures you about some abstract cholesterol score on a piece of paper. It’s another thing when the patient can see in real-time that his arteries are clogged up, and blood is struggling to get to his brain.
If I had seen that on the screen, I would probably have been scared straight and quit eating half of the junk I eat today.
“It’s quantitative, stratified, and provides a visual demonstration,” Goodwin says. “This shows the power of visualization at its best.”
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