SCOUT Radar Localization - Expanding to Europe, Middle East and Africa

A Physician’s Perspective on Wire-Free Localization

Everett Bonner MD - SCOUT Physician

INTRODUCTION

Everett Bonner, MD, is a general surgeon specializing in surgical breast oncology at the Baton Rouge Clinic a large, multi-specialty clinic in Baton Rouge, LA. Dr. Bonner joined the group after completing his Surgical Breast Oncology Fellowship at Memorial Sloan-Kettering Cancer Center, New York, NY.

Dr. Bonner performs on average 25-30 breast surgical procedures a month at Baton Rouge General Hospital, which implemented their wire-free program with SCOUT in 2019. Dr. Bonner led the SCOUT implementation and shares his perspectives.

What was your primary motivator in evaluating and switching to a wire-free technology?

I think the biggest motivating factor was the problems we had with wire localization. Let’s be honest, no one likes them, not the physicians and certainly not the patients. Wires were becoming dislodged; patients were a bit “freaked out” about a 10-inch wire hanging out of their breast covered by a paper cup.

I always thought sterilization was an issue. We are always so conscious of this in the OR, yet we have this 10-inch wire that was exposed to all kinds of elements for a few hours. I say that a localization with SCOUT facilitates a more sterile surgery.

I also perform Hidden Scar Surgery, and a wire localization made it very difficult for me to place the incision exactly where I wanted. Utilizing the SCOUT technology has eliminated that issue. I have total freedom to place my incision where the patient will not see it and have a constant reminder of her cancer. In a lot of my cases, I can make one hidden incision under the arm for the tumor and the sentinel node.

It has revolutionized my practice – it has been a game changer.

Were you familiar with other wire-free technologies?

SCOUT Radar Localization - Expanding to Europe, Middle East and Africa

 

We did not trial SCOUT first. We trialed two other wire-free options, and we were not very happy. With one we had to continuously adjust equipment, and with the other we would have needed to switch to a whole new standard of surgical instruments.

For us, SCOUT was the technology of choice. It was more user friendly, and we would not have to rebuy all new instrumentation. It has worked out extremely well for the hospital, for our practice, and we have never looked back. In fact, my associates and I now almost localize exclusively with SCOUT, and most of us have not used a wire localization in more than a year.

Since using SCOUT, how has it affected your surgical outcomes?

It has been a game changer in three key areas. First and foremost, my re-excision rate is down to less than 5% (the national average is about 10%). I spend less time in the OR, and infection rates have dropped.

I think a very important point is that I use SCOUT, not only for localization, but for real-time guidance during surgery. I am constantly using SCOUT as I am doing my circumferential dissection around the tumor. I am constantly relocating to make sure I am not too close to the tumor, and once I have removed the tumor, I do a margin assessment circumferentially. If it looks like I am too close into a particular margin, I will go back and take additional tissue.

Also, not to be minimized is the fact that I can perform a lumpectomy in about 30 – 45 minutes, as opposed to the hour and a half it normally takes with a wire localization. That is less OR time, less anesthesia for the patient, which all adds up to safety and cost savings.

What can you tell us from a patient’s perspective about a wire-free experience?

Patients love it! I do a lot of patient education upfront, and I am very detailed in explaining the whole surgical experience. I get rave reviews on how “cool” SCOUT, is and they love that they cannot see or feel it, especially patients who have had a past wire localization experience.

At first, I did get a bit of push back about making a trip to the hospital to get the reflector placed, but once I explain that it can be done in conjunction with pre-admission testing, that concern was alleviated.

Patients really appreciate the value of new technology. It is good for them and good for the practice. Being on the forefront of new technology has improved my patient volume. We do little advertising. Therefore, its popularity has been purely by word of mouth.

What are the main outcomes a physician should expect from their wire-free technology?

The number one thing is cleaner margins and the potential to decrease your re-excision rate. Like I mentioned before, my rate is now half of what it was with a wire.

Number two is patient comfort and satisfaction. Patients are nervous enough going to surgery. Add the discomfort and the trauma of a wire sticking out of their breast and that is not patient centric. SCOUT has changed all of that.

The third one, and I think also a major consideration, is precision. You can take less tissue because you know exactly where you are going as you dissect the tumor, which results in a more cosmetically appealing result. Some surgeons say, “Just take a larger tissue sample.” But my question is why when SCOUT is so precise? With this localization and guidance technology, you can take less tissue and have good margins as well as a better cosmetic outcome.


This information is for the practitioner’s convenience and for general information purposes only. This information does not constitute medical or legal advice, nor is it meant to endorse or guarantee the suitability of any of the referenced products or methods for any specific patient or procedure. Before using any product, refer to the Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use.
Physician Education - On-Demand and Live - Merit Medical

Continuing Education: Why It’s Vital to Improving Patient Care

Think Education™ proctors discuss the purpose continuing education serves in an evolving medical industry and how the Think Education program is paving the way for better learning opportunities now and into the future.

Physician Education - On-Demand and Live - Merit MedicalThe medical field is a continual evolution of new procedures and innovations. To bring these tools and techniques to practice, physicians take on the role of lifelong learners, making continuing education an integral part of their profession.

American Association of Continuing Medical EducationAccording to the American Association of Continuing Medical Education, continuing education is “crucial to the prosperity of healthcare providers, as it allows them to learn and discover viable ways to improve on the patient care they deliver and effectively manage a career in the ever-changing landscape of the medical industry.” 1

“Physician education allows us to remain at the forefront of knowledge,” says Darren Klass, MD, PhD, MRCS, FRCR, FRCPC, Think Radial® Proctor. “It has a dramatic impact on patient care in that it allows physicians to provide the latest treatment. In many instances, the procedure itself may not fundamentally change; however, new techniques and equipment that make the procedure safer and more effective can improve patient outcomes.”

Not only does continuing education keep physicians informed, it also helps to ensure patients are, too. Being aware of all treatment options can mean the difference between undergoing a minimally invasive procedure or conventional surgery. Utilizing less invasive techniques can minimize risk to the patient, reduce pain as well as recovery time in comparison to open surgery. 2

“Even if physicians are not bringing new skills and developments directly into their own working environment, the awareness of new alternatives is valuable,” explains Ferdinand Kiemeneij, MD, PhD, Think Radial Proctor. “Patients will benefit by either receiving state-of-the-art treatment, or they are at least aware of alternatives if the physician involved informs them properly.”

Merit Think Education - Physician CoursesMerit Medical’s Think Education program provides physicians with quality instruction that focuses on cutting-edge interventional technology and techniques, facilitating advanced therapies designed to provide a less invasive approach to treatment that results in better patient outcomes.

Program topics include interventional techniques for airway stenting, the implantation of LV leads, and minimally invasive treatment of pathologic vertebral fractures and metastatic spinal tumors. Other course topics include embolization for the treatment of symptomatic benign prostatic hyperplasia, peritoneal dialysis implantation, radial and distal access, and wire-free tumor localization. Explore Merit’s courses here.

Designed and taught by physicians, each course immerses attendees in a number of ways, including didactic presentations, taped or live cases, and state-of-the-art, hands-on training. Encompassing all aspects of a procedure or disease state, Think Education courses provide physicians with the up-to-date knowledge they need to immediately put what they learn into practice. Both virtual and on-demand courses are available.


Think Education Proctors - Drs Hallisey & Kiemeneij
Think Education Proctors - Drs Klass & Parkinson

“The courses evolve each time they are presented in order to provide physicians with the latest data and experience, presented in an unbiased way that is first and foremost about improving patient care,” Dr. Klass says. “Probably the biggest impact the Think courses have is their clear message of intercollegiate collaboration. Physicians are able to listen to experts speak on their respective fields—which is unique to the Think Education program.”

“Think Education is an invaluable asset to the medical community,” explains Brett Parkinson, MD, Think Wire-Free™ Proctor. “It provides opportunities for physicians to learn in a friendly, relaxed environment, and because course topics involve cutting-edge technology, attendees come away knowing they have added the latest treatment options to their armamentarium of care.”

“As a proctor for Think Education programs, I believe physician-to-physician interaction gives attendees confidence that they are getting experienced thought leaders in their field,” says Michael Hallisey, MD, Think Spine™ Proctor. “This gives them the chance to expand their knowledge and improve their medical practice.”

A current challenge physicians face in continuing their education and improving their practice is doing so in the face of a pandemic that requires rethinking traditional methods of instruction to minimize in-person interaction and spread of the disease.

Although education had started to move online long before COVID-19, this transition is now mandatory, at least for the foreseeable future. To make this undertaking easier, retaining real-time personal interaction can help online learning feel less isolating, fostering effective and sustainable experiences.3

Think Wire-Free with Dr Parkinson“The medical education of today will be of historical interest tomorrow. This has been evident over the last year, as the old educational paradigm shifted abruptly from large gatherings to individual learning in the comfort of one’s home,” Dr. Parkinson adds. “Think Education was able to effectively pivot in 2020 from in-person seminars to virtual learning.”

As continuing education adapts to the changing needs of physicians, it brings with it the opportunity to influence and improve future opportunities to learn, serving as a catalyst for better programs that have a broader reach.

“Physician education will continue to expand in the online format in the future. This can allow top physicians to share their expertise with a larger part of the world,” Dr. Hallisey says. “We all want more confidence and skill in treating patients. A well-educated physician can have that.”

Learn more about Merit’s Think Education program and sign up for an upcoming course today.


REFERENCES
1. American Association of Continuing Medical Education. 2020. “Importance of CME.” https://aacmet.org/cme/importance-of-cme/
2. Johns Hopkins Medicine. 2021. “What Is Vascular and Interventional Radiology?” https://www.hopkinsmedicine.org/interventional-radiology/what_is_IR.html
3. Chirag V et al. 2020. “Socially Distant Medical Education in the Face of COVID-19.” Med Sci Educ Oct 21: 1–3. PMID: 33106763

Uterine Fibroid Embolization - Embosphere Microspheres

Embosphere® Results in Less Inflammatory Response, Lower Rates of Analgesic Use Compared to PVA After UFE

Every July, our team at Merit Medical recognizes Fibroid Awareness Month as a time to bring attention to a very common yet under-discussed condition that will affect most women at some point in their lifetime.

We do this by supporting a minimally invasive fibroid treatment called uterine fibroid embolization (UFE), also called uterine artery embolization (UAE), through a portfolio of embolotherapy products we offer.

Uterine Fibroid Embolization - Embosphere MicrospheresTo shed light on the performance of UFE embolic agents and to help physicians ensure women receive the best fibroid treatment experience possible, a randomized controlled trial by Han et al. compared post-UFE pain using nonspherical polyvinyl alcohol (PVA) particles versus Merit Medical’s Embosphere® Microspheres.

Published in Radiology, the study enrolled 54 women with fibroids (mean age, 44 ± 4 years [standard deviation]) and assigned UFE treatment with either nonspherical PVA (355–550 μm) or Embosphere (500–700 μm). There were 27 women in each group, and both participants and investigators collecting data were blinded to the embolic material used. Women with concomitant disease (e.g., adenomyosis) were excluded from the study.

Both groups were given fentanyl-based intravenous patient-controlled analgesia within the first 24 hours after UFE as well as rescue analgesics. The investigators measured neutrophil-to-lymphocyte ratio to assess inflammatory response, and contrast-enhanced MRI was performed 1 day after the procedure to evaluate dominant fibroid necrosis and ischemia of normal myometrium. Symptom severity score and health-related quality-of-life score were assessed before and 3 months after UFE.

Results showed that pain scores and fentanyl dose were not different during the first 24 hours, but the use of rescue analgesics was higher in the PVA group (33% vs 11%; P = 0.049). After embolization, symptom severity score and health-related quality-of-life score were not different between groups (symptom severity score: 16 [interquartile range, 6–22] for PVA vs 19 [interquartile range, 9–34] for Embosphere, P = .45; health-related quality-of-life score: 93 [interquartile range, 80–97] for PVA vs 89 [interquartile range, 84–96] for Embosphere, P = .41).

In addition, changes in neutrophil-to-lymphocyte ratio from before to 24 hours after UFE were greater in the PVA group (3.9 [interquartile range, 2.7–6.8] compared to the Embosphere group (2.5 [interquartile range, 1.5–4.6]; P = .02). Rates of complete dominant fibroid necrosis were not different between groups, but transient global uterine ischemia of normal myometrium was more frequent in the PVA group (44% vs 15%; P = .04).

The investigators of the study concluded that when used in UFE, PVA particles and Embosphere resulted in similar pain scores and fentanyl dose. However, PVA resulted in a greater inflammatory response, higher rates of rescue analgesic use, and more frequent transient global uterine ischemia compared to Embosphere.

Watch How UFE Works

Fibroids (also known as uterine fibroids, leiomyomas, and myomas) are non-cancerous tumors that grow within the muscle tissue of the uterus. Although some fibroids cause no symptoms at all, common symptoms can include excessive menstrual bleeding, pelvic pain and pressure, and frequent urination. Depending on the size and location of the fibroids, other symptoms can include anemia, leg pain, pain during sexual intercourse, constipation, and an enlarged abdomen. Up to 80% of women develop fibroids by the time they reach age 50.

Approximately, 600,000 hysterectomies are performed in the US each year, with fibroids listed as the most common reason. A report by the Society of Interventional Radiology found that 1 in 5 women believe hysterectomy is the only treatment option for fibroids and that 44% of women with fibroids have never heard of UFE. Although hysterectomy is a treatment for fibroids, there are many other treatment options available, many of which are minimally invasive.

44% of women have never heard of Uterine Fibroid Embolization

To encourage women to seek out all treatment options and help physicians educate patients, we offer an educational patient-awareness site called Ask4UFE with information about treatment options—with focus on UFE—as well as patient and physician testimonials and researched blog entries.

Join us in recognizing July as Fibroid Awareness Month. We look forward to working together to increase awareness surrounding the condition, helping to provide the best resources, products, and care for patients worldwide.


Before using, refer to Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use.


ARTICLE REFERENCE
Han K et al. 2020. “Nonspherical Polyvinyl Alcohol Particles verusus Tris-Acryl Microspheres.” Radiology 298, no. 2 (Feb): 458–465. PMID: 33350893.