Fibroscan machine - correct operation of?

Hi All,

I just had a fibroscan with a machine and an operator newly arrived at my local hospital.  The probes are very expensive, by the way, so they had one probe only, medium size.  The operator steadied the probe on my lowest rib on my right side and took 10 shots of my liver, all in the same place.  I have no fat there so all the shots came out 100% valid.  

My question is this - is it good operating procedure to take all the shots in exactly the same place?  I had a fibroscan 3 years ago in another hospital and they moved the probe around.  They took more than 10 shots and averaged the final number.  

We know that it is a shortcoming of a liver biopsy that it gets info. on only the one spot where the sample comes out of.  I am not sure if the same applies to a fibroscan though.  Maybe one spot is good enough to probe as it resonates throughout the whole liver anyway?  

Anybody out there know anything about this?
Thanks,
dointime
  

[RobertBeWell]

Found this on the web at: http://www.ilbs.in/fibroscan.html

How does Fibroscan work?

The fibroscan machine uses a probe, similar to an ultrasound probe, which is kept on the right lower chest wall of the patient. Just by pressing a button the ultrasound probe sends a shear wave in to the liver and detects the stiffness of the liver. This data is automatically processed by the on-board computer and the liver stiffness is displayed on the screen. Ten such readings are recorded. Easy to perform, and rapid, the measurement is expressed with a clear figure in kPa. The patient lies on his/her back, right arm raised behind the head. The measurement is made on the right lobe of the liver by intercostal route using a dedicated probe with a vibrating system. The result is delivered at the end of the 10 acquisitions.

[Bali05]

fibroscan measures an area about 1000 x  larger than biopsy.

i believe it was one square inch , they told me the last time.

you can also get different areas by simply pointing the probe differently while

still pressed against the same spot on your abdomen.

[willing]

first, I hope your results were good ( or at least not a cause for concern).

I'm a  fan of FS - mostly because it (1) samples at a larger area and (2) avoids the subjective judgment involved in the pathologist's read of the slides. Re probe positions you might want to look at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712901
where they look at the effect of different probe positions on reading reliability. I've had two FS and in each case a certain amount of moving about was involved but that may have been more to identify a good probe position than to include multiple positions in the scan. The reading  success percentage and interquartile range are the usual indicators of reading consistency. The paper seems to indicate scanning a single position is standard - though interestingly  they recommend against looking at the spot where bx needles are usually inserted.

BTW, regarding the issue of bx as the fibrosis "gold standard" ,it looks like Keeffe (Stanford) is joining Afdahl (Harvard) in questioning how much gold is  in the standard:

http://www.ncbi.nlm.nih.gov/pubmed/20339187
"Invasive assessment of the liver can no longer be cited as a "gold standard," and at best can only be considered as an imperfect standard. Neither LB nor any single alternative option represents an absolute assessment of liver disease."

[Bali05]

i am a fan too. had 3 fs so far and they actually showed improvement

from the first  8.0 kpa to the last two both 5.9kpa

the hepatologist that did last one recommended one every 6 months

if not on tx. did my last one  as baseline that was in mid march.started tx beginning

may , probably will schedule one for aug-sept.

the big advantage with fs is it`s repeatability

now if only it were available everywhere and insurance covered.....

[dointime]

Definitely agree that I'm a fan of anything that doesn't involve sticking a big needle into my liver.  

Thanks for all your responses.  Seems that 10 valid shots is about right.  The operator used a single position and I didn't feel that she pointed the probe in different ways.  I think she did the 10 shots of the same place.  So that would be measuring one square inch of liver according to your info bali05.

Willing, that was an interesting article thanks.  They used a single position about an inch in front of the place where they did the biopsy.  My fibroscan position was similar,  ie. at least an inch, maybe 2 inches in front of where they stabbed me for the biopsy.

My result this time was 3.7.  Last time it was 4.5, so a good result showing that the virus hasn't done the nasty yet - but ofcourse one never knows when the damage is going to go exponential so no room for complacency.  I think I'll be able to get a fibroscan once a year from now on, which is great.  However the fatigue and just the sheer bummer of having the hepc threat hanging over me will still drive me to treat as soon as there is a viable tx available for me.  

dointime  
    

[pcds]

How does a fibro scan compare to MRI?

[tashka]

Fibroscan and MRI have different purposes. FS measures density of the liver. MRI is used to find tumours/lesions and can also show cirrhosis in advanced stage. MRI will not show milder fibrotic changes-stage 1-3 fibrosis. If your liver MRI is normal, you can be stage 1 as well as stage 3 and even stage 4 in some cases.

Sometimes CT scan fails to detect a small lesion, but it shows on MRI. Just like FS, MRI doesn't involve any radioactivity.

[pcds]

I had an ultra sound but this fibro sound it different, I'll ask my doc at my nex appointment
thanx

[Bill1954]

Unfortunately, Fibroscan isn’t FDA approved for commercial use in the States yet; there are several machines in use here, but it’s difficult to obtain an appointment. It was developed by Echosens, a French firm. It’s used extensively in Europe I believe; have any travel plans in the near future :o)?

Bill

[Bali05]

the cadillac of them all is a combination MRI and Fibroscan available at Mayo Clinic

Rochester. They put a pad (like a mousepad )over the  entire liver and than send you

in the MRI tube. The pad like Fibroscan measures stiffness levels of the entire

organ and combined with MRI you get geographical positioning.

End result looks like a weather map of your liver with all the different stages in

various colors. sweet !

Costs over $4000 unless you get your insurance to cover it , but only available

at Mayo so it means travel , hotel ect... plus i assume appointments are very hard

to get.

[susan400]

I've never had a fibroscan, so I don't know that I'm qualified to reply on your question.  I would happily have one if A.) there was one available to me in this county under my HMO or B.) if it was to be provided for free to me in a clinical trial.  I did however, just have my 5th biopsy last Wed., which I'm waiting for the results on.  I am one of the few people who really, really don't like biopsies.  I see all kind of posts on these boards from people who say, "they don't hurt", "they are no big deal", etc., etc.  On my 1st biopsy, I was very nervous and the doctor that I had at that time was a very big jerk.  He walked into the room, started yelling at the nurses and pitching a temper tantrum and throwing around his tools, all before he ever acknowledged my presence on the table.  So, immediately, I tensed up.  Then, w/o any pre-biopsy drugs, proceeds to do this biopsy (ultrasound guided).  Needless to say, it HURT bad.  I needed to have several shots of Demerol in the recovery room. I waited 5 yrs until I was prepared to go through that again!  The next time, I insisted on pre-biopsy meds. WAY better, but I still needed Demerol in recovery for post-biopsy pain.  3rd Biopsy had pre-biopsy meds, no Demerol was needed afterwards.  4th biopsy was done in a clinical trial and that doctor refused to give me any pre-biopsy meds and it killed me!!  What was worse, my friend and I had to get up at 3 am in the morning and drive 2-1/2 hrs to get to the hospital in Jacksonville to have it done. Then, after I was released, have her drive me home in w/me laying in the back seat, for the entire 2-1/2 hr drive home. Not pleasant!  The 5th biopsy that I just had on Wed., I had great pre-meds, but still needed a Percocet about 2-1/2 post biopsy, just 1, I didn't take any more than that.  However, it's been 6 days today and I still feel very run down.  I almost feel like I picked up a cold or something when I was there.  Anyhow, I would very much like to never have to ever get another biopsy for the rest of my life, if I could help it!  Bring on that Fibroscan!!   Susan400

[Bali05]

thanks for sharing this.

as long as the FDA does`nt sanction FS insurance won`t cover it.

what city are you in ?

all the best for your biopsy results.

do you have the same pathologists analyse your bx ?

[EyesofBlue55]

Sorry that you had such a bad experiences with a bx.I too was scared when I had my first in March,but they gave me some great pre bx meds and the nurse was fantastic!!!When the dr came in and introduced himself he actually explained what he was doing when he was doing it.I turned my head to talk to the nurse and before I knew it he was finished!!!I didnt even feel the needle!!!!!I think its the attitude of the drs and nurses that really meke a difference!!!

[Diane12855]

This sounds horrible, but I'm glad to read that somebody else had a hard time with a biopsy. Mine was horrible too, even though I had a great nurse and they gave me pre-bx meds. I have an hemangioma in the right side of my liver, so they did an ultrasound guided biopsy and went in to the right of my stomach about 2 inches, I was out for about 2 minutes of it and didn't feel the needle going in... or maybe it was a tube of some kind because when I came to I remember the doctor taking something out of me, placing it on a dish, and then re-inserting and getting 2 more pieces. I thought I had imagined it until I got a copy of the biopsy report where they listed 4 samples and the size of each. Then I had to lay on my stomach for 4 hours. When they got me up I had to have a percocet, and then in about an hour I started feeling nauseas and dizzy from the meds. I only had to ride for 45 minutes to get home... 2 1/2 hours would have killed me!!! I felt EVERY bump in the road. Come to think of it, the doctor told me ahead of time that it would feel like somebody punched me in the stomach... he was right about that!

By the time I was home for 3 hours I started throwing up, and I was sick all the next day too, but I'm pretty sure that was what they put me out with. The "punched in stomach" feeling lasted through the second day too.

As much as I hated it, I was glad that they actually had more than one piece to compare, and they weren't just guessing at what the machine was telling them.

[dointime]

5th biopsy!  It makes me feel sick just imagining what you have been through.  After my one and only biopsy I was d@mn sure they'd never get me to do it again unless it was an absolute emergency.  I had 2 anesthetic injections beforehand.  One at skin level and the 2nd into the liver sac before the needle went in.  The 2nd one hurt right up to my shoulder and I yelled my head off out loud.  There was a student in the room and I think I scared the pants off her.  The doc was very good, very experienced and smooth, but still.  After that I mercifully didn't feel any pain when the needle went in.  Afterwards I stayed in the hospital all night.  Going home afterwards would have been too brutal.        

There are not that many fibroscan machines here in UK either.  I have been bugging my doc at my local hospital to get one for the last 3 years and it finally happened.  I'm
really sorry to hear that it is not FDA approved and your insurance won't cover it.  For  a lot less than $4000, a trip to a European clinic could be arranged I am sure.  The result might not be accepted for some purposes but would save you from another biopsy if you just wanted it for your own information.  The scan itself takes a paltry 10 minutes and has no side effects so time left over for sightseeing.  

dointime              

[Bali05]

I flew to Germany from USA last year to get my first FS.

For the FibroScan + complete abdominal ultrasound and consultation

with Chief of hepatology at a liver center that uses FS already for 6 years

I paid 150 EURO plus travel.

[willing]

3.7! is that three-point-seven? I'd say that's good reason to relax, more than ample liver time to see it through... Congratulations!

[mk_]

Can you share some details about Fibroscan in Germany, such as location, appointment and your experience... etc. ? 150 euro is not bad, if one is in the neighborhood!  Thanks.

[Bali05]

http://www.uniklinik-duesseldorf.de/deutsch/unternehmen/kliniken/klinikfrgastroenterologiehepatologieundinfektiologie/diagnostischeundtherapeutischeverfahren/fibroscan/page.html

[merryBe]

Even though what you describe is pretty standard there are those who don't subscribe to the ten shot philosophy.

The reason that only one lobe or spot is probed in either a fibroscan or a biopsy is because of the erroneous view that the liver is homogeneous in it's degradation.

This is not always the case. It is usually the case, but not always. Some folks, particularly those who are on regimes to improve their liver health tend to show pockets of improved tissue. Even those who haven't done anything proactive also sometimes show these gradients, and there can be 3 or even 4 stages within the same liver.

The only reason I know these things is because of a doctor who is experimenting with the machine, and has discovered these findings with his patients. However don't hold your breath waiting for the Mayo technicians or whomever to get these reading on you.
It seems that faster is better these days (unless it's their liver).

I would recommend that you make notes when technicians scan you, be it with a fibroscan or an ultrasound. Those that take their time, and go back over areas you should take note of, and request for your next scan. Your life may depend on it.

Ultrasounds, for instance, are being used for HCC prevention (because they are cheaper than MRI's not because they are better...they are NOT better)....my tech takes 45 minutes...but many techs do it in half that time. Good for them, not so good for you!!
Better get the most thorough scan you can.

[dointime]

This is exactly why I posted this question here, because I had identical doubts about the 10 shot process and how much the result can be relied upon.  From what you've just told me, there's still a lot of room for improvement.  I am not able to control how these scans are done or by whom but I can note things like how much time is taken and probe locations and draw conclusions accordingly.  Many thanks for this info.

Willing - yes it is 3.7 - so the cubic inch of liver that was measured does indicate I have time to wait and I am grateful for it.  Bearing in mind MerryBe's answer though, I won't be hanging around waiting for longer that I have to!

dointime