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Sir,

We read with interest this article [1] about the application of ultrasonography in the screening for RCC. This work based on a 2-year follow-up of screened patients produced impressive results for detecting early RCC with consequent advantages to the patient. Undoubtedly the advances in radiological imaging, particularly that of ultrasonography, have increased the capability to detect early-stage disease [2]. This will allow nephron-sparing surgery or even newer techniques of ablative therapy to be used successfully [3]. Ultrasonography remains by far the safest, most patient-friendly and cost-effective imaging method for assessing the kidney but is a subjective test based mainly on the standard of equipment used, patient body habitus and most importantly the level of expertise of the examiner. Technical problems have largely been resolved by the introduction of newer capabilities, e.g. harmonic imaging, and microbubble-enhanced imaging aided by the digital capabilities inherent in all newer ultrasound equipment [4]. Expertise in ultrasonography remains a problem, but if targeted training is available, this too may be overcome.

All this is expensive and we find the value quoted in the study [1] of US $6.00 per investigation completely unrealistic. To consider all factors involved (equipment cost, room cost, staff costs, imaging capture and storage, ultrasound accessories) the cost per examination is likely to be much higher. In the UK the National Health Service operates a ‘provider-to-provider’ cost for each procedure, and currently this is £65.50 (US $105) per renal ultrasonography examination, still far below the cost quoted for the USA [1]. However, even had we been given our ultrasound machines and operators for free, we could not provide quality scans for $6.00! Hence we believe that although screening for RCC is possible, the expenditure even with screening ultrasonography is too prohibitive to make it a cost-effective exercise.