Dr Greg Lisciandro discusses the Global FAST system at BSAVA Congress 2023
28 March 2023
The BSAVA welcomed an American revolutionary to its annual congress in Manchester – A Texan vet who has transformed the way that pets are examined and treated in general practice.
Greg Lisciandro, a critical care and emergency clinician from Spicewood, near Houston was invited to receive the association’s prestigious Bourgelat award for outstanding international contributions to small animal practice.
Dr Lisciandro was responsible for developing the Global FAST system which uses ultrasound scans to quickly and accurately diagnose traumatic injuries, malignancies and a range of other conditions in companion animals. In doing so, he has changed the way that vets use ultrasound, from being a technology applied mainly in specialist referral centres into a vital tool for daily use by first opinion practitioners.
In his Bourgelat memorial lecture on March 25, Greg explained how he created the Global FAST system which uses a standardised views and probe manoeuvres to identify abnormalities in the patient’s abdomen or thorax.
FAST– Focussed Assessment with Sonography for Trauma – is an idea originally conceived by human emergency room medics in the 1990s. But Greg has adapted the concept for use in veterinary patients and developed it further and for a broader range of applications. Equally importantly, through his scientific papers, textbooks and lectures, he has opened the eyes of thousands of colleagues around the world to the potential applications of ultrasound technology.
Introducing her guest speaker, BSAVA president Alison Speakman recognised the impact of Dr Lisciandro’s work. “Global FAST is really a phenomenal technique which we should all be capable of using in practice. This doesn’t have to be something that can only be used by board-certified experts.”
But she cautioned that the system should only be used after receiving appropriate training. That training is available through his company, FASTvet.com and Greg has received service mark protection for his intellectual property to ensure the integrity and high standards of training received by his colleagues.
Initially, Greg developed a method for examining the patient’s abdomen, which called AFAST. He then created a technique for thoracic examinations, called TFAST and later a system for investigating the lungs, termed Vet Blue. These three methods were then combined into the GlobalFAST technique which enables colleagues to perform rapid exams of both the main body cavities in a matter of minutes.
This approach is a screening method that will identify what other diagnostic methods may be needed in situations where quick decision making may be vital. He has also shown that the vet can obtain valuable information without first having to shave the patient, and that high quality images are possible in a standing patient.
Curiously, when Greg himself was a general practitioner in the late 1990s he wasn’t impressed by the possibilities of diagnostic ultrasound. He took a course in abdominal ultrasound techniques and declared that “it will never be an achievable skill for me.” But later when he was undergoing his emergency and critical care training, he was persuaded by his supervisor to have another go.
He says he soon realised that routine use of ultrasound will provide a large amount of information that would be missed on a standard physical examination. Moreover, it will not only supplement but perhaps even supplant established diagnostic methods. “I think it is on its way to replacing the stethoscope as an instrument for investigating the lungs of our patients,” he predicted.
In some areas, Greg has taken the technology beyond the levels achieved by colleagues in human healthcare. He explained that he has developed techniques for accurately measuring the amount of fluid that is visible on the scan. This fluid may be blood, urine or the exudate present in patients with ascites. “In cases where there is an abdominal bleed, sequential scans will show whether the patient’s condition is getting better, stabilising or getting worse. This is an approach that is not yet available in human medicine.”
Dr Lisciandro told his audience that the examining vet should always be prepared to examine both bodily cavities and also to make repeated scans. This will greatly reduce the risk of confirmational bias which can occur when the clinician finds what they were expecting and stops looking, with the result that they miss vital additional information.
He believed that the GlobalFAST approach will be seen to be increasingly valuable in a growing range of clinical applications. He pointed out that is a very practical technique for monitoring the accumulation of fluid in the lungs of patients with congestive heart failure. This will not only help provide a more accurate diagnosis but will help the attending vet to provide better care – “if the patient is shown to have ‘dry lung’ there is no need to administer loop diuretics, which I believe is one of the most overused drugs in veterinary practice,” he said.
He also suggested that his methods will help save the lives of patients whose prognosis has been identified as poor using traditional diagnostic methods. He pointed out that ultrasound can clearly distinguish between different types of lumps in the chest or abdominal cavity. If the abnormality is wrongly assumed to be malignant then there is risk that the owner will ask for their pet to be euthanased.
Dr Speakman agreed that the greater degree of precision achievable with a diagnosis using these technologies would help colleagues to provide better care, particularly in difficult economic climate like today. “At a time when we are all being squeezed by a cost-of-living crisis, these simple and inexpensive techniques can give us so much information that help us and our clients to make decisions about how far they should ask us to proceed with treating their animal.”