Author Archives: aium14750

16 Years and Counting

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Every year I look forward to February for a number of reasons. One is that I know spring in North Carolina is just around the corner. Another is that I know I will be escaping to Florida for a long weekend to attend my favorite ultrasound course, the AIUM Advanced Ultrasound Seminar: OB/GYN.

NC spring

Spring in North Carolina from http://www.visitnc.com.

I am a general OB/GYN and have been in practice in Durham, North Carolina, since 1998. I chose my current position because of its location, my family, and the chance to continue teaching OB/GYN residents.

In my early years as a resident educator, it was easy to teach the residents. But as time has passed and I have gotten busier, it seems that the residents have gotten smarter. They know about changes in protocols, new medications, new technology, and more. Therefore it is important for me to continue to educate myself through reading, listening, and attending courses.

I have always had an interest in ultrasound and received a great introduction to scanning as a resident at the Medial University of South Carolina in Charleston. My program directors put a strong emphasis on using ultrasound as a tool for caring for OB and GYN patients. So I probably have an interest in ultrasound beyond most generalists and I have enjoyed coming to the AIUM course since 1999.

One of the great things about the course is that it has adapted so well with the times. I remember the first 3D and 4D imaging that this course covered and how many questions people had about how they would be used. I remember discussions about whether an anatomy scan would be worthwhile and if insurance carriers would pay for it.

In the early years of the course there would be many long lectures about the frequency of X, the p values of certain markers, the RR of this thing or that thing, unreadable tables and presentations, and more. Recently, however, the course has become more evidence-based and clinically relevant for all participants. This has made the course even more worthwhile and shows that the enthusiastic and collegial faculty have dedicated their lives to medical ultrasound.

As we begin to move into fall and then winter, I start to long for February—for obvious reasons. I hope to see you in Florida.

Is there anything you have attended for more than a decade? What made it special? Have questions about the AIUM OB Course? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Frank Frenduto, M.D., is a managing partner and a board member for the Women’s Health Alliance in Durham, NC. His special interests are high-risk pregnancies, laparoscopic surgery, and gynecologic ultrasound.

Simulators Role in Ultrasound Training

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I believe the future of health care will involve the expanded use of diagnostic ultrasound, which will be accomplished through the use of an enhanced version of today’s handheld ultrasound scanner. I envision this “sono-scope” to be a wireless, lightweight, handheld imaging device with a long battery life and high-quality image capture that will expand the capabilities of the stethoscope.

The compact, portable ultrasoundpedersen_image scanners began entering the medical imaging marketplace around year 2000. Since then the market has grown dramatically, and the portable scanners have bifurcated into two broad groups: (i) The pocket-sized or handheld scanners (HHUS) and (ii) the larger, full-featured point-of-care ultrasound systems (POCUS).

These devices provide doctors with an extension of their senses and augment existing tools. But to be truly transformational, users need to receive ultrasound training from the beginning of their medical career, which will allow them quickly to “rule in” and “rule out” possible diagnoses and lead to earlier treatment decisions and/or more relevant further tests.

I maintain that the main barrier for making the HHUS (and POCUS) every clinician’s examination tool of choice, is not the technology, but rather the lack of opportunity to acquire and develop the needed scanning skills.

Thus, finding training strategies that enable the integration of ultrasound into medical schools is an essential step in overcoming this barrier. If the next generation of doctors had ultrasound for diagnosis and guided procedures as a vital part of their training, they would quickly develop a natural comfort with this tool and, with time, increasing sophistication. A parallel can be drawn regarding the attitude toward acquiring computer skills. As recent as 40 years ago, the operation of computers was thought to be limited to a select, carefully trained group of specialists. Today, nearly everyone is able to operate computers at some level.

Effective training in medical ultrasound requires both clinical knowledge (understanding of anatomy, physiology, and pathology) and scanning skills (psycho-motor skills, which are the integration of motion and the mental processes of recognizing anatomic structures in 3D from the 2D images). While both clinical knowledge and scanning skills are essential, the former is often emphasized at the expense of the latter because clinical knowledge can be delivered cost effectively and in flexible formats through online courses (including MOOCs), self-study, and in traditional classroom courses. Scanning skills, on the other hand, are acquired through hands-on experience, by examining patients, preferably both healthy and with symptoms, under the guidance of an experienced sonographer. Here, the medical educational enterprise does not currently have the capacity to meet this training need. There are too few scanners available for learners to use. There are too few patients or human subjects in general available for scanning. Last but not least, there are too few qualified instructors who can guide the learning.

There exists a potentially effective approach to overcoming this limitation in delivering scanning skills training: The use of ultrasound training simulators. Simulation provides a controlled and safe practice environment to promote learning. The efficacy of the simulator-based training is well-established. For example, human errors related to airline accidents have decreased in large part due to flight simulator training. Likewise, high-fidelity medical simulations have been shown to be educationally effective, as evidenced by the strong correlation between surgical simulator training and improved outcomes. Several studies have demonstrated the learning value of simulator-based training in diagnostic ultrasound.

Just as HHUS and POCUS have proliferated over the last 15 years, so have ultrasound simulator products. Some training simulators cover multiple clinical specialties, while others are designed for a specific application. Typically, the learner scans a physical manikin with a realistic-looking sham transducer, which produces an image on the display corresponding to the position and orientation of the sham transducer on the manikin, along with an anatomy display of the location of the image plane through the body.

An important component of the simulator design is the degree to which the simulator provides structured learning with guidance, interaction, and assessment. While all simulators include educational modules, only a few offer self-paced learning and competence verification. All in all, today’s ultrasound simulators are sophisticated devices that are capable of meeting training needs on basic and even intermediate levels. However, because the purchase price is sufficiently high (from $10K to more than $100K) sonography programs and simulation centers at larger hospitals are typically the only facilities able to acquire this technology.

When the medical community is ready to embrace ultrasound as an imaging modality of first choice for doctors from all specialties, I am convinced that technological innovation will lead to affordable, yet customizable and realistic training simulators. In particular, what is needed are portable and lightweight simulators that run on ordinary, modern PC/laptops, making personal ownership of a simulator possible as well as allowing medical schools to purchase such simulators in large quantities. For individualized training, it is essential that the simulator be task-based and able to verify the acquired skills level. To deliver the best realism, the image material should preferably be acquired directly from human subjects, and to provide the optimal development and assessment of psychomotor skills, the scanning practice on the simulator should resemble actual patient scanning as closely as possible. Such low-cost training simulators can lay the groundwork for building up such ultrasound skills both among practicing specialists and students enrolled in medical schools.

Have you/do you use simulators in your ultrasound training? What are the advantages or disadvantages? What would make simulation training better? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Peder C. Pedersen is Professor of Electrical and Computer Engineering at Worcester Polytechnic Institute.

Medicine, Music, and Moonlighting

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I love my day job as a gynecologic oncologist at Princess Margaret Cancer Centre in Toronto as well as my role as the clinical lead for Royal Victoria Regional Health Centre regional gynecologic cancer program in Barrie, Ontario. My work keeps me very busy as do my three beautiful daughters. With great friends and family, and some of the best support staff any doctor could ask for, I’ve achieved my goal of becoming a successful doctor and surgeon for women with cancer. But I’ve always had another dream tucked away.

Dodge 2I’ve always been musical – in fact at age 3 I started playing the accordion, which I’m pretty sure was bigger than I was! But I put my musical dreams on hold while I pursued a medical career. I learned to play piano, percussion, and brass, and dabbled with songwriting over the years but most of my time was devoted to my medical training at Western University and University of Toronto.

A few years ago a patient in the palliative care ward asked me to play for her. I brought in my piano and surprised her with an original song I’d prepared for her titled, “It’s So Hard to Say Goodbye.” It was an emotional afternoon and afterward she made me promise that I would pursue my love of music professionally. Well, two albums later, here I am working on my third with two very accomplished and talented songwriters, Steve Dorff (whose songs have been sung by legends Barbra Streisand, Celine Dion, and Whitney Houston, to name a few) and Paul Overstreet (who wrote the number-one hit “Forever and Ever, Amen” for Randy Travis).

Many people ask me how I find the time to be a doctor at two hospitals and a professional musician.

Sometimes after a challenging day at the hospital, it can be hard to do anything at all, let alone write and play music. But music never feels like a chore. It calms my spirit and brings me a sense of peace. I find that music has a unique healing power both for me and for people going through tough times, whether struggling with illness or other personal issues. I always say that my goal is to share my music with as many people as possible with the hope that it will bring to them the same sense of passion, peace, and fulfillment it has brought to my own life. Here are a few ways in which music helps to heal both patients and myself.

How Music Helps Patients

  1. Pain relief
    Overall, music does have positive effects on pain management. It can help reduce both the sensation and distress of chronic pain, postoperative pain, and a range of conditions, according to a paper in the Journal of Advanced Nursing.
  2. Immunity boost
    Music can boost the immune function. A comprehensive study on the neurochemistry of music explains that a particular type of music can create a positive and profound emotional experience, which leads to secretion of immune-boosting hormones as well as endorphins. Listening to music, dancing, or singing can also decrease levels of the stress-related hormone cortisol.
  3. Increase energy and fight fatigue
    Many of my patients sometimes suffer from fatigue due to treatment or the postoperative healing process. Losing themselves in music helps reduce physical and emotional stress and can chase negative emotions away. Musical distraction can also help with sleepless nights.

How Music Helps Me

  1. Staying positive
    Music improves my moods and creates a more positive state of mind that helps me through busy days and emotional times.
  2. Mental and physical workout
    Music helps with concentration and staying focused. In addition, playing the piano improves motor coordination and dexterity – very beneficial when I’m at the operating table.
  3. Calm and cool
    The medical field can be very high-stress and emotionally taxing. Going home and playing the piano or writing lyrics really helps me channel this energy in a positive way. And music has been shown to help lower heart rate and blood pressure, which is great for my long-term health.

How does music affect you? What activities help you escape? How do you balance the demands of the job with your personal interests? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jason Dodge, MD, Med, is a surgical oncologist at Princess Margaret Cancer Centre in Toronto. He participated in the AIUM International Consensus Conference on Adnexal Masses in 2014. You can check out his music on his website or on iTunes.

5 Questions with Dr Lee

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Every year, the AIUM William J. Fry Memorial Lecture Award recognizes an AIUM member who has significantly contributed in his or her particular field to the scientific progress of medical ultrasound.

Wesley Lee MDAt the 2015 AIUM Convention, Wesley Lee, MD received this award.

  1. What did being named the William J. Fry Memorial Lecture Award winner mean to you?

The William J. Fry Memorial Lecture Award was an unexpected surprise because all of my professional accomplishments simply reflect who I am and what I enjoy doing.  I am truly honored and feel privileged to have received this special recognition among my special friends and colleagues.

  1. You have been involved with the AIUM for more than 3 decades. From your perspective, how has the AIUM changed over that span?

Over the past 3 decades, I have seen enthusiastic growth within our membership and more diversified multidisciplinary collaborations between many specialties for various areas of diagnostic and therapeutic ultrasonography. The AIUM has certainly raised the bar for technical and clinical practice standards that are now often developed with other professional organizations. The AIUM plays an pivotal role for political advocacy involving important issues that may impact how cost-effective and health care is delivered.

  1. You have written extensively and currently serve on the editorial board for Ultrasound in Obstetrics and Gynecology, as well as deputy editor of the Journal of Ultrasound in Medicine. Based on what you are seeing and writing, where is medical ultrasound headed?

The quality of medical ultrasound research has improved with the use of standard writing guidelines and detailed imaging protocols, as well as the application of evidenced-based medicine. We are seeing many novel applications of ultrasound technology that can now be delivered or used in combination with other imaging modalities in our patients. The Journal of Ultrasound in Medicine has become an important international resource with submissions from all over the world.  Original research articles constitute approximately 60% of the total papers submitted.

  1. What medical ultrasound question or concern keeps you up at night?

We use ultrasound imaging technology every day in our clinical practices. I am constantly trying to understand how diagnostic ultrasonography practice can be improved for patient care through development/application of new technologies, better education, and innovative research initiatives.

  1. Finish this sentence…”It’s best to use ultrasound first when…”

It’s best to use ultrasound first when providing obstetrical care to pregnant women because of its cost-effectiveness as a screening tool, established benefit for the prenatal diagnosis of fetal anomalies/complications, and long safety record in pregnant women.

Do you have any questions for Dr Lee? Comment below or let us know on Twitter: @AIUM_Ultrasound. Learn more about the AIUM Awards Program at www.aium.org/aboutUs/awards.aspx.

Wesley Lee, MD, is Co-Director, Texas Children’s Fetal Center at Texas Children’s Hospital Pavilion for Women. He is also Professor, Department of Obstetrics and Gynecology; Section Chief, Women’s and Fetal Imaging; and Director of Fetal Imaging Research all at Baylor College of Medicine.

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Start Spreading the News

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I have some very exciting news!

Are you ready?

The 2016 AIUM Annual Convention is moving to New York City and the New York Hilton Midtown! That’s right, the AIUM Convention is moving from Las Vegas to New York City.

aium16About a month ago, the AIUM was presented with an opportunity to return its signature event to New York City. Now, New York has always been a great city for the AIUM Annual Convention, but we were already committed to Las Vegas.

Before we explored the opportunity, however, we did some research. We looked at our existing city pattern, which didn’t have us returning to New York until at least 2022.  We reviewed the evaluations from the times we were in New York and found that attendees and exhibitors gave the city really high ratings. And, of course, we reviewed the terms of the offer.

With all of this positive feedback, we decided to pursue the opportunity a little further. In a move that even surprised us, Las Vegas was willing to release the AIUM from its commitment without any penalty. Another positive sign.

The only thing left to do was sign the final contract with New York—which we did this morning. The dates are now March 17-21, which also changes the day pattern to Thursday-Monday. While we know these changes might inconvenience some participants we believe that the return to New York, along with having the bulk of programming on the weekend, will allow even more AIUM members to attend.

We still have a lot of details to work out over the coming weeks so keep reading Sound Waves, checking www.aium.org, and reading your email. In the meantime, add the new dates to your calendar and circle October 14—that’s when registration and housing will officially open.

Oh, and help us out by spreading the news!

Keep watching AIUM’s communications for more information on this change. What do you love about NYC? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Carmine M. Valente, PhD, CAE, is AIUM’s Chief Executive Officer. He is an avid Yankees fan.

15 Tips to Accreditation Success

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Every day, the AIUM receives applications for AIUM accreditation. Some of these are pristine and go quickly through the process. Others require follow up which can delay the process—sometimes significantly. If your practice has decided that 2015 is the year it will seek accreditation, we have come up with 15 ways to help you improve your application.

For all practices: aium_accred

  1. Contact information—You’d be amazed at how many applications fail to include contact information on reports. Make sure you also include accurate email addresses, street addresses and phone numbers on the application. Doing so helps the overall process run more smoothly.
  2. Support all information—If you are reporting information that can be supported by an image or a short video clip, make sure it is included in your case submission. AIUM receives numerous applications where things like measurements, pathology and anatomy are reported but no supporting images are included.
  3. Sign and date your reports—Even if the report is dated, the physician needs to not only sign the report but also date his or her signature. This shows the timeliness of the report as well as your internal review process.
  4. Report your CME credits—Accreditation requires that all physicians have a certain number of CME credits. Before you submit your application, double check that all the included physicians have the necessary CME credits.

For OB practices:

  1. Image the adnexa—This is one of the required images so make sure you include and label it!
  2. M-mode not Doppler— In order to be compliant with ALARA, use M-mode first. If M-mode is unsuccessful then Doppler can be used keeping in mind the AIUM Statement on Measurement of Fetal Heart Rate.
  3. Report number of fetuses—There are multiple ways to report the number of fetuses and can be documented anywhere on the report. Some examples include: Fetal 1/1, singleton, Number of fetus = 1.
  4. Be careful of the thermal index—Monitor the thermal index. Keep this displayed at all times, if possible. Review the AIUM Statement on Heat.
  5. Include ALL third trimester anatomy—This is true even if you perform mostly growth sonograms in the third trimester. For accreditation purposes, make sure your third trimester submission is a complete anatomy study.

For GYN practices:

  1. Get correct volume measurements—When reporting uterine volume the measurement of the uterine corpus must be submitted. If your practice does not report uterine volume then measuring the length of the uterus must be from the fundus to the external os.
  2. Report uterine orientation with sonographic terminology—Anteverted, retroverted, anteflexed or retroflexed must be used to report uterine orientation. “Normal” is not appropriate sonographic terminology.
  3. Report the use of transvaginal probe/transducer—If you used a transvaginal probe/transducer, make sure you report it.

A few more:

  1. Limit images with anisotropy (MSK practices)—Aligning the transducer perpendicular to the structure will eliminate anisotropy.
  2. Images not labeled (MSK, dedicated Thyroid, Fetal Echo practices)—A good mantra to follow is, “If it’s an image, label it.” If you follow that, you will avoid one of the most common mistakes that slow down the review of an accreditation application.
  3. Include images of all cardiac biometry (Fetal Echo practices)—This is required for accreditation and yet practices fail to submit these images. Don’t forget.

Following these tips will help ensure your application is complete and goes through the accreditation process as smoothly as possible. At any time, however, feel free to call the AIUM at 800-638-5352 or email accreditation@aium.org if you have any questions. Good luck!

Is your practice accredited or considering the accreditation process? What questions do you have? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Therese Cooper, BS, RDMS, is AIUM’s Director of Accreditation.

I Enjoy Being a Detective

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I chose the specialty of radiology, and subsequently diagnostic ultrasound, because I enjoy the “detective” aspect of medicine. It is exciting to use diagnostic imaging to attempt to determine the cause of a patient’s illness. Obstetrical ultrasound has been of interest because most pregnant patients are healthy and happy and one always got an answer, whether right or wrong, 20-30 weeks hence.

I began my career in ultrasound in 1976 joining Dr. Roy Filly at UCSF. He and I are still practicing (perhaps the longest pair in academic medicine). The early days of arguing whether it was better to view images as white on a black background or black on a white background and whether static articulated arm scanning was better than “real-time scanning” are long gone, replaced by incredible technology.

Peter CallenThe pitfalls of image analysis has been a curiosity of mine. I have always been intrigued as to how one looks at a series of images and achieves the right (or occasionally wrong) conclusion. I am thrilled that most medical centers are introducing diagnostic ultrasound to medical student teaching early in their training. This has helped generate a lot of awareness and better understanding of our specialty. I am proud to have been a member of our organization, the AIUM. While there are some that only know the AIUM for its guidelines, it has served as a strong core of support for our specialty for the past several decades with support and advice to and from ultrasound professionals, including physicians, sonographers, scientists, engineers, other healthcare providers, and manufacturers of ultrasound equipment. This award is especially meaningful to me to be included with the true founders and leaders of our specialty.

What is your story? Why did you start using ultrasound? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dr Peter Callen received the 2015 Joseph H. Holmes Clinical Pioneer Award from the AIUM. Dr Callen’s contributions span decades and he is currently Emeritus Professor of Radiology, Obstetrics, and Gynecology at the University of California, San Francisco.

Ultrasound Can Catch What NIPT Misses

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A few months ago a young couple, Michele and Dan, came to my office for a mid-trimester fetal anatomic survey at 21 weeks’ gestation. They were excited to see their fetus in 3D-4D ultrasound, and were wowed by the 3D image of their baby’s face. During the scan the couple related that they were sure their baby was OK “because the blood test came back negative,” and had decided to forego first trimester screening, despite their OB strongly recommending it.

unnamedThe blood tests, nuchal translucency measurement, and other sonographic parameters evaluated in first trimester screening are considered together to provide a risk profile for fetal chromosomal anomaly, particularly the risk of Down syndrome. If there is an increased risk, the parents may be advised to undergo invasive testing, such as chorionic villus sampling (CVS) or amniocentesis. In addition, first trimester screening can raise warning flags for structural anatomic malformations in the fetus, as well as other problems for the pregnancy. If first trimester screening includes a full fetal anatomic survey, it can spot about 40% of fetal malformations at a very early stage.

While I was reassured that Michele and Dan’s results on noninvasive prenatal testing (NIPT) meant the risk of their baby having Down syndrome and certain other aneuploidies was extremely low, I explained that structural malformations were still a much more common concern than chromosomal anomalies, and that a negative NIPT result did not rule out other conditions. Michele protested, “On the Internet it said that the blood test rules out Down syndrome 100%, that we didn’t have to worry.”

“The screening tests only give you a risk profile,” Dan insisted, “they don’t tell you if the baby is really affected. So we thought the blood test was the way to go.”

“I don’t want to have an amnio,” Michele continued, “I had a miscarriage in my last pregnancy,” she continued, as I proceeded to the echocardiography portion of the examination.

“Your baby appears to have a heart defect,” I said, as gently as I could, and began to explain the nature of transposition of the great arteries (TGA).

NIPT is the name applied to new techniques that use a sample of a pregnant woman’s blood to examine her fetus’s chromosomes. As early as 10 weeks of pregnancy there is sufficient fetal genetic material, called cell-free DNA, found in the maternal serum to allow analysis. A negative result from NIPT is a very good test to rule out Down syndrome in the fetus: it is highly specific, meaning that in almost all cases, a negative result is truly negative. NIPT is also highly sensitive, which means that in almost all cases, a positive result is truly positive. However, because there is a chance (however small) of a false positive (a healthy fetus may have a result showing him/her to have Down syndrome), a positive test result always needs to be confirmed with invasive testing, such as CVS or amniocentesis, before any decisions are made regarding the further management of the pregnancy. NIPT has also been found useful in identifying fetuses with other chromosomal anomalies and certain other genetic conditions. NIPT can also be used to determine the fetal sex.

However, while NIPT does a very good job at what it is designed for: looking at fetal chromosomal complement in specific conditions, it does not examine all the fetal chromosomes, nor does it look at the anatomy of the fetus. Fetal anatomy is examined in detail by ultrasound scanning. There is some debate among practitioners regarding the optimal week of pregnancy when full early fetal anatomy scanning should be performed. Some practitioners prefer performing the scan at the time of nuchal translucency screening, 11-13 weeks, while others prefer 14-16 weeks, when the fetal organs are more developed. The important point to remember: a fetus with a normal (negative) NIPT result can have an anatomic structural malformation. It has been shown that while fetuses with malformations may be at increased risk of chromosomal anomaly, the majority have healthy chromosomes. The diagnosis of a malformation by ultrasound should prompt invasive testing such as CVS or amniocentesis. In some centers, more detailed investigation by chromosomal microarray analysis (CMA), which may discover subtle anomalies, will also be ordered. CMA detects duplicated or deleted chromosomal segments and translocations—rearrangements of chromosomal structure, which may not be evident on traditional karyotyping.

NIPT is a very reliable test. But patients may have a false sense of security regarding their baby’s well-being. A negative NIPT result cannot rule out anatomic structural malformations in the fetus, nor does it rule out all chromosomal anomalies. There is ongoing debate surrounding the integration of NIPT into existing screening programs.

I continued to follow Michele and Dan in the weeks and months that followed. They were, of course, shocked and dismayed by their diagnosis. With Michele at 21 weeks, we immediately arranged multidisciplinary consultation with the cardiologists, who explained the procedures the baby would have to undergo, and how Michele’s plans for the birth would have to change. Prenatal diagnosis of TGA can improve the baby’s surgical outcome, and with prompt intervention, prognosis is excellent. They met with a genetic counselor, and despite Michele’s fears, underwent amniocentesis. CMA is performed in all such cases in our center. Testing ruled out genetic syndromes that we suspected based on the anatomic malformation, none of which could have been diagnosed by NIPT.

With comprehensive information in hand about their baby’s prognosis and the options open to them, Michele and Dan decided to continue the pregnancy, despite the difficult road they knew was ahead. They made arrangements for delivery in the tertiary care center where the baby would undergo surgery, so she would not have to be transferred from their community hospital and would be under constant surveillance. “I fell in love when I first saw the baby’s face in 3D,” she told me. “Whatever comes, we’ll handle it together.”

How do you think NIPT should be integrated into prenatal care? How do you advise your patients who ask about NIPT? Have you encountered patients with negative NIPT results whose fetus has a structural anomaly? Have you encountered patients with false negative or false positive NIPT? Comment below or let us know on Twitter: @AIUMultrasound.

Simcha Yagel, MD, is Head of the Division of Obstetrics and Gynecology Hadassah-Hebrew University Medical Centers, Jerusalem, Israel, and Head of the Center for Obstetric and Gynecological Ultrasound at the Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem. He served as moderator for a panel discussion, “Noninvasive Prenatal Testing and Fetal Sonographic Screening,” that appeared in the March 2015 issue of the Journal of Ultrasound in Medicine.

Why I Applied to be an AIUM Fellow

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Working in an academic department, we are encouraged to become involved in the ultrasound community as well as keep abreast of the constantly changing field of sonography. After attending my first AIUM Annual Convention early in my career, I quickly realized that the AIUM was an organization in which I wanted to become more involved. The knowledge base was high and many of the members were and still are leaders in research, clinical work and patient care. It was confirmation that I make an impact on patient outcomes every time I pick up a transducer.

TBpixAs a reflection of that, I wanted to grow in my AIUM membership. I took the first step in 2005 when I applied for senior membership status, which I was happy and proud to be awarded in the spring of 2006. It took me several years to take the next step, but after meeting the membership requirements, I applied to be an AIUM Fellow. It was a great feeling when I was notified that I had joined the exclusive ranks of AIUM Fellow.

Going through this process was both a professional and personal goal. It was and is an honor to be individually recognized by my peers on both a national and international level.

For those of you interested, the overall application process was straightforward and didn’t take a lot of time to complete. It was pretty clear and straightforward. Plus, the AIUM staff was excellent in keeping me updated on the process and deadlines. There were definitely times when I needed a reminder.

We are all busy with our professional and personal lives; however, I am excited and proud to have taken the steps to illustrate to myself and my peers how much I value my career in ultrasound. I appreciate the AIUM for identifying the substantial effort ultrasound professionals put forth daily for the accurate diagnosis and safety of patients.

What’s your membership story? What accomplishment are you most proud of? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Teresa Bieker, MBA, RT, RDMS, RVT, RDCS, FAIUM, is Lead Diagnostic Medical Sonographer at the University of Colorado Hospital.

Only 260 AIUM members have applied and been granted the distinction of being an AIUM Fellow.

Why My Relative is a Bad Writer

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A relative of mine, whose privacy will be maintained, fancies herself a writer. Historical fiction is her self-proclaimed genre. Unfortunately, she is not a good writer and reading her stories is akin to listening to nails scratching a chalkboard. My suggestion to her, without revealing how I truly felt about her writing, was to read as much historical fiction written by others as she possibly could. Her response was, “I don’t like reading other people’s fiction.” You can imagine how hard it was to restrain the thought that ran through my head, “Now you know exactly how I feel about reading yours.”

HellerThe point of this anecdote is to help explain why I decided to become a reviewer for the Journal of Ultrasound in Medicine (JUM). You cannot possibly expect to be a good manuscript writer without reading as many manuscripts written by others as you can. And what’s even better than reading an already edited and published “fit-to-print” manuscript is to read one in its gestational state, (sometimes) full of awkward sentences, confusing presentations of data, and tables that are impossible to digest.

When I was first invited to become a reviewer for JUM, I was (presumably jokingly) instructed by top editorial staff members to “ignore the email invitation at your own peril.” Being a first-time manuscript reviewer can be a bit intimidating. You begin to question your own qualifications: “What makes my opinion valuable?” “Who am I to criticize someone else’s writing?” As a regular reader of this or any medical journal, you are exactly the person from whom opinions and criticism count. You are the intended audience of the writing and, as such, the manuscript needs to appeal to you, not only in medical accuracy, but also in relevance and in the style in which the information is presented.

A good manuscript needs to be consistent. It needs to flow effortlessly and consistently from abstract to discussion. The first step I take in reviewing a manuscript is to read it from beginning to end, without making any suggestions. I want to digest the information in the state in which it was originally presented. While this can sometimes lead to indigestion and heartburn, I resist the urge to scribble any comments, questions or suggestions along the margins of the article…at this point.

I wait anywhere from several hours to several days to allow my digestive tract to return to normal (I find probiotics to be particularly helpful for this). Then I reread the article more carefully and more slowly, dissecting each sentence, in particular the data, making sure that information is consistently presented throughout the paper and that the numbers add up. I avoid correcting grammar and linguistic choices (my grandmother, the eternal grammarian, would roll over in her grave), knowing that there are great copy editors who will take care of this. I do ensure, however, that I correct any words that are medically inaccurate (i.e., incorrect abbreviations, suboptimal word choices for ultrasound techniques).

In addition to confirming that the information is presented in the correct section, (i.e., results are not included in the materials and methods section), I ask myself what I would do differently if I were to write the paper. Is the number of subjects adequate? Does the work add substantially to the literature? Is the conclusion appropriate for what was actually done? Might the work alter medical care? Are there any pertinent articles that have not been included in the references section? Do the tables help to more clearly represent the results or are they unnecessary? Is JUM the appropriate journal for this article?

In summary, the more articles you read and, in particular, the more unedited articles you read, the better a manuscript writer you will become. Of this, I am certain.  Whether or not you choose to write scientific manuscripts, historical fiction or perhaps screenplays for the next hit HBO series, the more you know about what’s already out there and how it was written, the better your own work will be.

What are your writing, reading, editing tips? Have you ever written for JUM? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Howard Heller, MD, specializes in diagnostic radiology at Brigham and Women’s Hospital, Department of Radiology. He is also on JUM‘s editorial advisory board.