New rheumatology clinic offers ultrasound imaging

North Valley Hospital’s newest clinic is believed to be Flathead County’s first rheumatology clinic that uses ultrasound imaging to diagnose arthritis.

Dr. Daryl MacCarter said North Valley Rheumatology opened this winter and is booked through April.

“In the past, a doctor saw through his stethoscope,” MacCarter said. “Now, I use ultrasound as my eyes.”

MacCarter adjusted a screen displaying a patient’s hand and pointed to splintered streaks of white above a knuckle — deposits of uric acid on the surface of the joint, a sign of Gout arthritis.

MacCarter said an X-ray would not have displayed the deposits. Without using ultrasound imaging, he would have relied on a patient to pinpoint their pain and feeling for landmarks to perform joint and tendon sheath injections.

The machine is the same basic technology used to look at weather systems, ocean depths and unborn babies.

But it’s been slow to catch on in American rheumatology clinics.

According to a survey by the New York University Hospital for Joint Diseases, roughly 20 percent of rheumatologists in the United States use the tool.

Within Montana, there are two known doctors using ultrasound as their guide.

MacCarter said many doctors resist relying on ultrasound imaging because the learning curve is steep and the equipment is expensive. Many doctors don’t want to spend $40,000 on a machine, he said.

“They think, like I almost did, ‘I’ve been doing this for years, I’ve got my hands and my own knowledge,’” he said. “One could argue that’s good, but I think this is better.”

MacCarter began using ultrasound imaging 25 years ago when he worked at a clinic in Idaho and his partner asked to buy the machine.

Initially, he thought it sounded like a waste of money.

“But the more I learned about it, the more I realized American doctors were the exception, that this was already widely used in other parts of the world,” he said, “which makes sense. You wouldn’t drive a car blindfolded, why would I drive a needle without seeing its destination?”

Dr. Minna Kohler, director of the Rheumatology Musculoskeletal Ultrasound Program at Massachusetts General Hospital, said ultrasound has been used in Europe for diagnostic and needle guidance applications for more than 20 years.

“There is significant evidence in the literature supporting its use for expediting diagnosis of inflammatory arthritis and needle guidance for injection accuracy,” Kohler wrote in an email.

She said in the past 10 years, American rheumatologists have begun to incorporate the new tool in clinical practice. A 2015 survey by the American College of Rheumatology reported that 94 percent of rheumatology training fellowships are now teaching musculoskeletal ultrasound.

After years of feeling for arthritis, MacCarter had the ability to look at it on a patient. He said he could identify the arthritis and give the patient an injection for the swelling in one visit.

MacCarter said he became obsessive about learning more. He finished a rheumatology fellowship at the University of Michigan, attended conferences from Florida to Barcelona, Spain, and has taught courses on the practice throughout the United States.

He believes 50 percent of his injections without the tool were unsuccessful. On average, his patients returned saying they felt 20 percent better. Now, his patients report feeling 80 percent better, he said.

MacCarter retired from the practice in Boise and picked Whitefish as his new home. But he still loved the practice and decided to work part time in a Coeur d’ Alene clinic where an ultrasound imaging machine was available. Within four years, he had to drive to Washington 47 times.

Then he looked closer to home where he saw a convenient solution — he wanted to work and the Flathead Valley had a need he felt like he could fill.

“I could have retired years ago, but I’m here because I want to be,” MacCarter said. “It’s like a puzzle, putting together someone who has aches and pains. And this tool has increased my ability to do that, which is fun.”

Reporter Katheryn Houghton may be reached at 758-4436 or by email at khoughton@dailyinterlake.com.