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My wife lives with a 10, beware of poorly trained FibroScan operators

I just had my 6 month hepatologist meeting.  At issue was whether the chemo drugs treating my multiple myeloma had damaged my cirrhotic liver.

A bit of background, I was diagnosed as cirrhotic in January 2015 with a FibroScan score of 21.5. This was confirmed with both biopsy and MRE.  Over the next three years I was able to reduce that to 9.6, again confirmed with MRE.  I had been stable until my cancer crisis last year.

In December 2023 I had a FibroScan which was reported as 24.1 (a really scary number suggesting I was headed for decompensation).

I wasn't having active symptoms and I didn't have confidence in the tech who got that high reading. She had started in the wrong rib pair which was my first clue. Nonetheless it was with some nervousness that we went to this latest hepatologist consult.

This time, at our insistence, the doctor performed the test himself.  His analysis showed that my liver is a 10. We were greatly relieved.

This is a very stark example of the challenge with FibroScan.  Too many people are doing them who are poorly trained which leads to a lot of confusion for patients and physicians.  FibroScan is an excellent tool when used by well trained personnel but it can be subtly deceptive.  It looks so easy, but there is judgement involved in knowing whether it is actually measuring liver tissue and is not confounded by improper placement in the intercostal space.

MRE is far more reliable because it doesn't rely on operator skill.  They put a thumper on your chest and just whack the whole area so it is very repeatable. Sadly it is also a lot more expensive.

When you deal with a FibroScan, it is fair to ask about how many the technician has done and what kind of training they have had.  When we used the system for our SUNN study we were trained by the most experienced trainer FibroScan had at the time and he was very careful to explain to our nurse the various ways a test could fail and how to know when it was right. By the time she had 50 scans under her belt she as quite proficient and I didn't worry about the quality.

My concern today is with the device becoming part of the standard of care training is suffering. I frequently get questions from patients who have widely varying indications of their disease depending on what series of tests they have had.  This also leads to the physicians who feel that the system simply isn't adequate.

Training for a widely diverse staff is always difficult.  As a patient, if the result doesn't make sense, see if you can get them to repeat it.  Understanding the problem is the first step toward solving it.