The value of ultrasound imaging within MSK practice is ever more widely understood, but there are significant challenges to be faced for the practitioner seeking to apply it in practice.  This is a skill learned through experience.  Attending courses gets you started and delivers the foundations for techniques, but if you don’t have a scanner it is very difficult to hone the necessary skill through repetition and practice.  So if you don’t have access to one to practice with, it’s difficult.

What comes first?  Going to courses or getting a scanner?  In reality, the two are pretty closely matched together; once you decide to get trained, you really have to take the next step of acquiring a scanner to enable you to consolidate your skills.

How much should you budget?  What are the key considerations, and how should you look to go about buying your first machine? Buying any ultrasound scanner for your own practice is a significant investment, but the sheer range of models and prices is vast; a premium scanner of the type in use in a typical Radiology department for MSK scanning will normally have cost upwards of £70,000.  On the other hand, you can pick up a laptop style ultrasound scanner, new, for less than £1,000 online.  Then of course there is the second hand or refurbished option.  It’s very confusing and a potential minefield.

The first obvious thing to do is go to a course, see what’s being used on the course, and ask the trainers for their opinion.  The second obvious thing to do is seek advice from people you know who are using ultrasound in their practice already.  What did they start with and why?  How did it go?  What would they have done differently with the benefit of hindsight?

Here’s a few tips to start the ball rolling.

How will you build up skill?

You’ve got to start with normal anatomy, to learn to associate the ultrasound appearances and patterns seen on the screen with known anatomical markers and manipulate the probe from those markers to locate and view the musculoskeletal structures you’re interested in.  Buy a good textbook which shows you both the anatomy and the ultrasound image.  Use the scanner with the book open.  Scan yourself or a willing partner, sit in on colleagues clinics or MSK lists and absorb information.

Alongside this, you may find there is benefit in the ability to have a mobile ultrasound system which enables you to carry the scanner from place of work to home, and even to courses you may want to attend in future, so that teachers teach you and help you on the scanner you use. So, look at portability and practicality.  If the scanner is bulky, heavy and takes minutes to set up, that is a disincentive to getting it out and using at every opportunity.

What is acceptable image quality?

This is the tough one.  It all depends what you start with.  Bear in mind that the experts of today learned their craft when even the best scanners were far more basic.  The skills of pattern recognition are probably best learned on a fairly simple scanner; when you graduate to your next machine, you will want to do so for the right reasons and with skills developed enough to expand your practice.  Better image quality and more functionality is then important, but you will also have established those benchmark skills and will understand and appreciate the reasons why you are paying more money.

Is second hand the right route?

For sure it’s a route.  You can find some very good value offers out there.  Bear in mind that the second hand scanner will probably be at least three and more likely five years old, and may well have had a pretty hard life.  If it was used in a hospital, be cautious; hospital equipment is held ‘in common’ open for anyone in the department to use so may have had a hard life.  In that context, it is probably safest to look at buying a fully refurbished system, ideally from the original manufacturer, which will naturally also give warranties on it.  The downside of doing that is that it increases the cost, and at the end of the day, you are still buying a scanner that’s several years old.  You may find new systems with equivalent or better performance for similar price to the refurbished unit.  The alternative is to find the scanner equivalent to that ‘nice little car that’s had one careful owner who has hardly used it and cared for it immaculately’.  Good luck with that!

How can I buy one?

Then there’s the question of how you pay for the scanner.  As with buying a car (again), there are a number of options.  The most efficient, as long as you have the money available, is simply to pay for it in full.  The other obvious one is to get someone else to pay, probably the organisation you work for.  That brings up the tricky issue of building a justification, and most organisations will have their own processes which you will have to follow.   However, for simplicity let’s consider the private acquisition options.  They are, hire purchase; a lease and rental.  With hire purchase, you pay for the scanner over a series of regular instalments and eventually end up owning the equipment in full.  Normally, a proportion of the value is paid up front as a deposit, and then the balance is paid off.  Interest will be paid on that part of the deal as this is effectively a loan.  With rental, you pay a fee to use the equipment for an agreed period and never own it.  Leasing is simply either a form of rental or a form of hire purchase.  If the lease offer does not mean you own the equipment at the end of the agreed period, it is a rental; if the lease offer means you own the equipment at the end of the end, then it’s a form of hire purchase.

Hopefully these small reminders have helped to get those thoughts organised.  The best solution is the one that works for you, so no recommendations here on the equipment itself.  Get perspective and your choice will become clear.