Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts had used this technology before. One had not used the technology but had relevant expertise.

Level of innovation

All 4 expert commentators stated that the technology was novel. The commentators noted that there are other ultrasound devices that could produce 3D images, but no other technology can image an entire blood vessel at once. One commentator noted that the company will soon launch a portable version of the device that is small and light enough to be transported and used in the community.

Potential patient impact

Three expert commentators noted that using PIUR tUS avoids exposure to ionising radiation and nephrotoxic contrast media from CT scanning. Three commentators noted that using PIUR tUS would mean quicker results (because of availability of ultrasound imaging), shorter appointments and faster interpretation of results, compared with CT scans. Two commentators noted that scanning might be more convenient for patients because they would not have to travel to a centre with a CT scanner. One expert commentator stated that 3D ultrasound can measure change in aneurysm repair. This is a more sensitive marker than the diameter measurements produced by 2D ultrasound.

Potential system impact

Three expert commentators noted that PIUR tUS is significantly cheaper than CT scanning. Two commentators stated that using PIUR tUS would also increase CT scanner capacity for other patient groups and would release time for interventional radiologists. One commentator noted that patients would not need to be admitted to hospital for intravenous fluids as they would for CT angiogram. Two commentators noted that images from PIUR tUS could be directly interpreted by clinicians who would otherwise rely on reports from ultrasonographers. One commentator explained that PIUR tUS is more expensive than standard ultrasound because it is an additional technology. One commentator noted that using PIUR tUS could become cheaper than duplex ultrasound because it is quicker and needs less training, but duplex ultrasound may be preferred in some cases. One commentator felt that CT angiogram could still be needed if the images from PIUR tUS were inadequate. One commentator noted that sonographers will need training to use PIUR tUS and that standard and quality governance procedures would be needed.

General comments

One expert commentator noted that because of inappropriate reimbursement codes and not being included in guidelines, 3D ultrasound is not widely used in the NHS.

One expert commentator stated that their centre used PIUR tUS for a pilot research project. The other 2 commentators used the device regularly.

The expert commentators noted that this technology could be used in several other patient populations including those with occlusive vascular disease, asymptomatic carotid disease, and accessible tumours. It could also measure carotid plaque volume to estimate stroke risk, plan arteriovenous fistula formation for haemodialysis and select potential autologous grafts for peripheral and coronary artery bypass.

One expert mentioned that the detection rate of endoleaks for PIUR tUS is higher than for current methods (50% compared with 20%). They noted that this could mean that PIUR tUS is oversensitive and might identify clinically insignificant endoleaks.