Purpose: ERUS is the gold standard imaging for staging of rectal neoplasms. It determines location, distance, penetration depth, regional lymph node status, and is critical to guiding treatment of rectal cancer. ERUS allows the evaluation of the tumor postoperatively as a means of minimally invasive and cost-effective local surveillance for local recurrence. ERUS was not available at the Raymond G. Murphy VAMC in Albuquerque, New Mexico before 2010 so veterans were outsourced to other facilities for screening. This resulted in delaying treatment up to 12 weeks. Thirty-nine percent (7/18) of patients were delayed over 30 days to the start of treatment. Cost to the institution was fee for service $2,500 and loss of revenue-specialist consultation/procedure.
Methods: In 2010, the NMVAHCS purchased a BK medical ultrasound with a rigid rectal probe. A standard operating procedure was established as well as training for staff on the actual procedure as well as the cleaning and disinfection of the equipment. The physician, a fellowship trained colorectal surgeon, took a refresher course on ERUS as well.
Results: The first ERUS procedure was done on June 15, 2010. Since that time the outsourcing of rectal ultrasounds has ceased. A total of 78 patients have been referred to colorectal surgery for ERUS staging and surveillance. We have calculated a cost savings to the institution of $195,000 for fee basis of the procedure. In addition the Raymond G. Murphy VAMC has benefited in revenue earned for the specialty consultation and cost of the procedure. Most important, we have decreased the time from the initial consult to ERUS completion to 7-10 days. This gets our veterans to their definitive cancer treatment faster. Additionally, it provides continuity of care by keeping everything in the VA system and making it easier for ongoing surveillance.
Conclusions: ERUS is the imaging modality of choice. It is user dependent. However, it remains the most economical when compared to MRI. It is a relatively simple and inexpensive tool that can be utilized in the clinic setting. The patients benefit from expedited staging and quicker onset of treatment for rectal cancer.
