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The question: My doctor referred me to an orthopedic surgeon for my persistent knee pain. The surgeon wants me to get an MRI, but I have to wait two months for an appointment. Is there another way to find out what is wrong with my knee?

The answer: There actually is specialized equipment that can provide a quick assessment in a doctor’s office. It is called a NanoScope and it’s essentially an imaging-chip sensor – or camera – on the tip of a needle.

“You just poke the needle through the skin into a joint, such as a knee, and you get a high-resolution picture of what’s inside,” said Dr. Jihad Abouali, an orthopedic surgeon at Michael Garron Hospital in Toronto. “You are able to diagnose injuries on the spot.”

Videos and still images can be recorded and then stored in the patient’s medical records.

Dr. Abouali said the technology represents a “revolutionary” advance in arthroscopy, a minimally invasive form of surgery in which medical instruments are inserted through tiny “keyhole” incisions to diagnose and treat joint problems.

Arthroscopy is normally performed in a hospital operating room and the patient is put to sleep.

The NanoScope is just 1.9 millimetres in diameter – about the same width as the carbon graphite in a pencil. Because it is so small, the patient needs only a local anaesthetic at the site of the injection.

Made by Arthrex, a U.S.-based orthopedics company, the NanoScope was approved for use in Canada in September 2019.

But don’t expect to see it in your doctor’s office any time soon. The major hurdle to its wider use is the cost.

The scope can be used only once because it’s not possible to resterilize between patients. “The gold standard to sterilize medical devices is through steam autoclave, which would destroy the inner workings and optics,” said Tim Laudel, director of operations for Tribe Medical Group, which distributes the device in Canada.

So after it has been stuck into a patient, it must be discarded. Each scope costs about $750, Dr. Abouali said.

“The device itself is certainly pricey,” said Dr. Moin Khan, an associate professor of orthopedic surgery at McMaster University in Hamilton.

Of course, it’s possible that a hospital could decide to use the NanoScope in select cases and absorb the expense of the equipment in its overall budget.

However, “to gain the true power of this tool, its use needs to be expanded to clinic settings where many patients are seen out of hospital, " said Dr. Vickas Khanna, an orthopedic surgeon and director of the orthopedic residency program at McMaster.

And yet it is in clinics where the cost seems to pose an almost insurmountable barrier to its adoption.

“There’s currently no way for a doctor to send a bill to the government and have it reimbursed – and it’s difficult for patients to afford,” Dr. Khan said.

Even so, some doctors think the NanoScope has the potential to shorten certain surgical wait times, which have grown substantially longer during the past two years because of delays caused by the COVID-19 pandemic.

In Ontario, for instance, patients who need a “rotator cuff” shoulder operation usually wait an average of seven months from the time they are referred to see an orthopedic surgeon until the day when they are wheeled into an operating room.

“A large part of the delay is waiting for diagnostic imaging,” explained Dr. Ujash Sheth, an orthopedic surgeon at Sunnybrook Health Sciences Centre in Toronto. He noted that surgeons often rely on MRI images to plan an operation.

“It can take one to three months to get an MRI. But, realistically, it’s more like three months to get an MRI for most non-urgent cases,” he said.

“If we could make a diagnosis in the office using needle-camera arthroscopy, we could immediately discuss treatment options with the patient – and if that includes surgery, it would cut down on the time that the patient has to wait.”

Meanwhile, the NanoScope has been eagerly embraced by many doctors in the United States where insurance sometimes covers the cost or patients pay for it themselves.

U.S. studies have found that the acceleration of treatment makes the scope economically competitive with an MRI. The fact that patients get can quicker medical care means they recover faster and are able to return to regular activities – including employment for those who are off the work because of an injury. And that makes the device more cost effective when compared with an MRI.

Furthermore, in some cases, the NanoScope can provide better digital images than an MRI, so a surgeon is more likely to accurately diagnose a patient’s condition.

However, the United States has such a different health care system that “you can’t take data from there and say they’re applicable here,” Dr. Khanna said.

What’s needed, he said, is a Canadian study. “Let’s see if it has an impact on wait lists and actually accelerates the delivery of care. You can’t ask governments to open up their pockets to pay for this unless you have evidence.”

Dr. Sheth thinks more research is also needed to determine the best uses of the scope. Most of the published studies have focused on knees, while only a few have involved shoulders and ankles. “Before we all jump on the bandwagon, we need to assess the appropriate indications.”

Mr. Laudel said the company would gladly help fund such studies and provide the equipment for clinical trials. But Tribe Medical’s efforts to expand the use of the NanoScope in Canada have met with a lukewarm response. So far, only a few dozen surgeons have learned how to use the equipment at the company’s training centres in Vancouver, Montreal and Mississauga.

The pandemic has been partly responsible for curtailing training activities, Mr. Laudel said, but he readily acknowledges the biggest obstacle is money.

Canadian interest in the device could pick up significantly when the company introduces a reusable optical scope, for which price may be less of a sticking point.

“Our goal is that in the next 12 to 18 months we will have another version that can be sterilized up to five times,” Mr. Laudel said. “The cost will come down to potentially under $200 per use.”

If the price does indeed drop to possibly less than the cost of an MRI image, “that could be a game changer,” Dr. Khanna said. “You might see this device in just about every orthopedic clinic going forward.”

Paul Taylor is a former Patient Navigation Adviser at Sunnybrook Health Sciences Centre and former health editor of The Globe and Mail.