Empowering OB/GYN Trainees Through Point-of-Care Ultrasound: Bridging Imaging and Clinical Care

Posted on December 9, 2025 by aium1952

Point-of-care ultrasound (POCUS) has rapidly become an essential advancement in modern clinical practice. By bringing real-time imaging directly to the bedside, POCUS allows the same clinician who examines the patient to also visualize anatomy, assess pathology, and immediately act on findings. This integration of imaging and decision-making has made POCUS indispensable across multiple specialties, and obstetrics and gynecology are no exception.

The American Institute of Ultrasound in Medicine (AIUM) has long recognized the importance of standardization and quality in ultrasound practice. Its Practice Parameter for the Performance of Point-of-Care Ultrasound¹ provides clear specifications for evaluating the abdomen, retroperitoneum, thorax, heart, and extremities for deep venous thrombosis. These guidelines form the foundation for ensuring that the benefits of POCUS—speed, accuracy, and accessibility—are balanced with safety and quality.

POCUS in Everyday OB/GYN Practice

Within obstetrics and gynecology, POCUS is a natural extension of bedside care. On labor and delivery units, it enables rapid assessment of fetal presentation, amniotic fluid, and placenta and fetal well-being through biophysical profiles. In emergency and postoperative settings, clinicians can use POCUS to quickly evaluate for intraperitoneal free fluid, aiding in the diagnosis of ruptured ectopic pregnancy or postoperative bleeding.

Evidence continues to support the diagnostic reliability of POCUS in OB/GYN. For instance, Boivin et al² evaluated its accuracy in diagnosing retained products of conception in 265 patients. They found that point-of-care ultrasound demonstrated a sensitivity of 79% and specificity of 93.8%, validating its value in streamlining diagnosis and guiding timely management.

Training Gaps and the Case for Structured Education

Despite its broad applicability, ultrasound training in OB/GYN residency and MFM fellowship remains highly variable. Currently, emergency medicine is the only specialty with formal requirements for ultrasound training and credentialing. This gap has led to inconsistent proficiency among new OB/GYN graduates, even though ultrasound is fundamental to the specialty.

A structured curriculum in POCUS can address this gap. Training should combine didactic instruction, hands-on scanning, and supervised image review, building both technical skills and diagnostic reasoning. Defining competency benchmarks and maintaining image portfolios reviewed by credentialed sonographers or MFM faculty can help standardize skill acquisition and ensure quality.

Expanding POCUS Applications in Obstetric Critical Care

POCUS offers unique advantages beyond fetal and gynecologic imaging, particularly in the management of acutely ill obstetric patients. In the setting of hypertensive disorders, sepsis, or peripartum cardiomyopathy, bedside ultrasound can provide immediate insights into maternal cardiopulmonary status.

Lung ultrasound helps identify pulmonary edema, distinguishing cardiac from non-cardiac causes of dyspnea.
Cardiac views allow assessment of contractility and pericardial effusion.
Inferior vena cava (IVC) measurements help estimate fluid status and guide resuscitation in acutely ill patients.

Learning Early, Learning Effectively

Training in ultrasound doesn’t have to wait until residency. Vyas et al³ demonstrated that even first-year medical students could perform a basic obstetric triage scan after only twelve hours of training. Students correctly identified fetal lie, placental location, amniotic fluid index, biparietal diameter, and head circumference in more than 90% of cases, showing that structured, feedback-driven instruction can produce reliable results even among novice learners.

Sustaining Competence Through Practice

Ultrasound is a skill that requires repetition, reflection, and review. A comprehensive program should integrate longitudinal opportunities for scanning, image storage, and expert feedback. Access to curated image archives can help trainees build pattern recognition and diagnostic confidence. Incorporating POCUS assessments into rotations, such as emergency triage, obstetric critical care, or ultrasound electives, reinforces learning through real-world application.

Conclusion

Point-of-care ultrasound represents both an art and a science, merging clinical intuition with immediate visual data. For OB/GYN residents and MFM fellows, POCUS is not simply a diagnostic adjunct but a core competency that enhances patient safety, efficiency, and confidence at the bedside.

By embedding structured POCUS training and competency assessment into OB/GYN education, we can ensure the safe and effective use of ultrasound in medicine. Doing so ensures that the next generation of clinicians will not only interpret images but truly see their patients more completely, more immediately, and more compassionately.

References

1. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. J Ultrasound Med 2021; 40(8):E34–E52. https://doi.org/10.1002/jum.14972

2. Boivin J, et al. Utility of Point-of-Care Ultrasound in the Diagnosis of Retained Products of Conception. J Obstet Gynaecol Can 2020; 42(4):440–446. https://doi.org/10.1016/j.jogc.2019.08.026

3. Vyas KS, et al. Point-of-Care Obstetric Ultrasound Training for First-Year Medical Students in Rural Settings. J Ultrasound Med 2018; 37(3):715–722. https://doi.org/10.1002/jum.14404

Ruchira Sharma, MBBS, MD, FACOG, is a Maternal-Fetal Medicine Specialist, Director of MFM Fellowship, and Director of the Obstetric Ultrasound and Antenatal Testing Unit at Rutgers Robert Wood Johnson Medical School.

Sara Buhmaid, MD, is a Maternal-Fetal Medicine Fellow at Rutgers Robert Wood Johnson Medical School.

Ruchira Sharma, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. 10/25/2021 Photo by Steve Hockstein/HarvardStudio.com

Ultrasound’s Hidden Superpowers and Why We Celebrate Them Every October

Posted on October 14, 2025 by aium1952

Every October, the medical imaging community comes together to observe Medical Ultrasound Awareness Month (MUAM), a period dedicated to raising public understanding of the ultrasound’s vital role in healthcare. Sponsored by organizations such as the American Institute of Ultrasound in Medicine (AIUM), the American Registry of Diagnostic Medical Sonographers (ARDMS), the American Society of Echocardiography (ASE), Cardiovascular Credentialing International (CCI), the Society of Diagnostic Medical Sonography (SDMS), and the Society for Vascular Ultrasound (SVU), MUAM seeks to dispel the common misconception that ultrasound is mainly for pregnancy and to shine a light on its many other life-changing uses.

While many people immediately think of fetal imaging when they hear “ultrasound,” that’s only one of many applications. In fact, ultrasound helps patients at every stage of life, from newborns to seniors, across numerous medical fields. MUAM is a perfect time to celebrate the often-unseen breadth of ultrasound and the professionals who use it.

Why a Special Month for Ultrasound?

Ultrasound is safe, widely available, and cost-effective. Because it doesn’t rely on ionizing radiation (as with X-rays or CT scans), it offers a gentler imaging option, particularly for soft tissues.

The purpose of MUAM is to encourage professionals to educate patients, colleagues, and the public about how ultrasound supports diagnosis, monitoring, and treatment across a diversity of conditions.

Beyond Babies: Diverse Applications of Medical Ultrasound

Here’s a look at just a few of the many ways ultrasound is used outside obstetrics:

1. Cardiac / Echocardiography

Ultrasound is widely used to visualize the heart’s structure and function, assess valve integrity, detect fluid around the heart (pericardial effusion), and monitor things like left ventricular ejection fraction.
Doppler ultrasound can also show blood flow velocities, helping to detect stenosis or regurgitation in valves.

2. Vascular and Circulatory Imaging

Doppler vascular ultrasound can assess veins and arteries, detecting blockages, clots (eg, deep vein thrombosis), or stenosis.
It’s used to examine carotid arteries (for stroke risk), peripheral arteries (leg circulation), and vascular grafts.

3. Abdominal and Pelvic Imaging

Ultrasound is often used to evaluate organs like the liver, gallbladder, spleen, kidneys, pancreas, and bladder.
It can detect gallstones, kidney stones, hydronephrosis, liver masses, or fluid collections (eg, ascites).
In the pelvis outside pregnancy, it helps assess uterine/ovarian pathology, fibroids, pelvic fluid, or masses.

4. Musculoskeletal (MSK) Imaging

Ultrasound is used to image muscles, tendons, ligaments, joints, and nerves.
It helps in diagnosing tendon tears, bursitis, muscle strain, nerve entrapment (eg, carpal tunnel), and joint inflammation.
It also guides injections or aspirations.

5. Pediatric Imaging

In infants and children, ultrasound is often the first-line imaging for soft tissues, head/neck, hips (developmental dysplasia), and neonatal brain (via fontanelles).
Because it’s radiation-free, it’s especially favorable for young patients.

6. Point-of-Care Ultrasound (POCUS)

In emergency, critical care, and bedside settings, physicians use handheld or portable ultrasound to rapidly evaluate ailments such as fluid around the lungs (pleural effusion), free fluid in the abdomen, cardiac tamponade, or guidance during central line placement.
This real-time use can expedite diagnosis and treatment.

7. Interventional / Intraoperative Ultrasound

Surgeons sometimes use ultrasound during procedures to locate lesions, guide resections, or assist in biopsies or ablations.
Interventional radiologists may use ultrasound guidance for needle placements (biopsy, drainage) and local therapies.

8. Therapeutic Ultrasound & Special Applications

Beyond imaging, ultrasound has therapeutic uses (eg, high-intensity focused ultrasound, ultrasound-assisted drug delivery).
In neurology and neuroscience, for example, therapeutic ultrasound is being explored in treating conditions like Alzheimer’s disease or other brain disorders.
In space medicine, ultrasound is one of the few imaging options available aboard the International Space Station (ISS). As part of the Advanced Diagnostic Ultrasound in Microgravity project, astronauts use ultrasound to assess various organ systems in microgravity.

How You Can Support Ultrasound Awareness
(Especially This October)

Share knowledge: If you’re a clinician or educator, talk with colleagues or patients about the many roles of ultrasound.
Use social media: Companies and organizations often use hashtags like #MUAM2025 to share educational images, infographics, or stories.
Celebrate sonographers and ultrasound technologists: Recognize the skill, dedication, and meticulous work of these professionals.
Invite engagement: Host a webinar, post Q&A content, or distribute simple “Did you know?” facts about ultrasound to patients.

Final Thoughts

Medical Ultrasound Awareness Month is more than a promotional event. It’s an opportunity to correct a common misconception: ultrasound is not just for pregnancy. From the heart to the knees to the kidneys, even to outer space, ultrasound plays a vital, versatile role in modern medicine.

Let’s use October’s spotlight to help people see inside, not just for babies but for better health at every age.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Ultrasound That’s Out of This World

Posted on November 26, 2024 by aium1952

The 2025 AIUM Annual Meeting promises to be an extraordinary gathering for the medical community, spotlighting technological advancements and groundbreaking research in medical ultrasound. Central to this event will be the keynote speakers, each of whom has made significant contributions in their respective fields. From space medicine to neurotherapeutics, these thought leaders will share their unique insights and provoke discussions that extend beyond traditional medical paradigms. Here’s a closer look at the distinguished keynote speakers you won’t want to miss.

Dr. Leroy Chiao, PhD – “Is It SADS, or Am I in Space? Medical Considerations for Spaceflight”

Dr. Leroy Chiao, former NASA astronaut and commander of the International Space Station (ISS), will help kick off the event on March 30, 2025, with his keynote presentation, “Is It SADS, or Am I in Space? Medical Considerations for Spaceflight.” Dr. Chiao’s pioneering experience as one of the first astronauts to use and study ultrasound in space has positioned him uniquely to discuss the challenges faced by humans in extraterrestrial environments. His session will delve into the physiological effects of space travel, weaving together his personal experiences and stories from his missions. He will also highlight the dual advancements made in operational countermeasures and diagnostic ultrasound during space missions, and how these innovations have been adapted for healthcare solutions on Earth.

Attendees will gain insights into how space-based medical research contributes to groundbreaking practices that benefit terrestrial healthcare. Dr. Chiao’s expertise and captivating storytelling will shed light on the often-overlooked yet critical connection between space exploration and medical innovation.

Dr. Scott Dulchavsky, MD, PhD – “Extraterrestrial Medical Care”

Following Dr. Chiao’s presentation, Dr. Scott Dulchavsky will present his keynote, “Extraterrestrial Medical Care.” A leader in surgery and aerospace medicine, Dr. Dulchavsky is a professor of surgery, molecular biology, and genetics at Wayne State University and Michigan State University, and a principal investigator for NASA. His contributions have earned him a place in the Space Technology Hall of Fame, emphasizing his pivotal role in translating space medicine technologies for Earth-bound use.

Dr. Dulchavsky’s talk will focus on the vital role of ultrasound as a diagnostic tool in space missions. Point-of-care ultrasound has become an indispensable resource for managing potential clinical conditions in space—enabling immediate, noninvasive diagnostics. This capability is crucial for long-duration missions where traditional medical facilities are not accessible. His presentation will provide attendees with a deeper understanding of how these space-driven advancements in ultrasound can enhance medical practices and patient care back on Earth.

Dr. Ali Rezai, MD – “Focused Ultrasound: Breaking Barriers in Neurotherapeutics”

On the second day of the meeting, Dr. Ali Rezai, a visionary neurosurgeon and the head of the Rockefeller Neuroscience Institute, will present his keynote, “Focused Ultrasound: Breaking Barriers in Neurotherapeutics.” Dr. Rezai is a pioneering figure in the field of neuroscience, known for developing treatments for complex brain disorders such as Parkinson’s disease. His research has been featured in prominent media outlets including The New York Times, The Washington Post, BBC, Good Morning America, and 60 Minutes.

In his session, Dr. Rezai will explore how focused ultrasound is being used to treat some of society’s most pressing neurological challenges, including Alzheimer’s disease and addiction. He will share the latest developments in soundwave therapy, illustrating how noninvasive focused ultrasound can offer new solutions to slow the progression of Alzheimer’s and manage its debilitating symptoms. Additionally, Dr. Rezai will discuss how these innovative treatments are opening doors for addressing addiction, showcasing the versatile power of ultrasound in neurotherapeutics.

Don’t Miss This Unparalleled Opportunity

The 2025 AIUM Annual Meeting is not just an event—it’s a platform to explore the intersection of advanced ultrasound technology and its revolutionary applications in healthcare. With keynote speakers like Dr. Leroy Chiao, Dr. Scott Dulchavsky, and Dr. Ali Rezai, attendees will be inspired by stories that span from space to the operating room and will walk away with newfound knowledge applicable to advancing their own practices.

This is a unique opportunity to learn from the world’s leading minds and be part of conversations that shape the future of medical ultrasound and patient care. Learn more about The Ultrasound Event and register to join us from March 30 to April 1, 2025.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

The Growing Role of Ultrasound in Addressing Complications in Aesthetic Medicine

Posted on August 20, 2024 by aium1952

A patient we’ll call Janet contacted our clinic in a state of distress. What began as a seemingly benign bruise a day after her chin and jawline filler injections spread to her cheek and forehead. Subsequently, her eyelids became bruised and edematous, and purple marks appeared on her temple, tracing the path of her arteries. When she sought help from the clinic that administered the injections, the doctor was unavailable. It took days before she was finally diagnosed with vascular occlusion and began treatment, which included hyperbaric oxygen therapy, aspirin, hyaluronidase injections, and even Viagra to improve blood flow. Yet, the sinister purple marks continued to spread, and the areas remained exquisitely painful. With a growing sense of alarm, she reached out to our office.

In aesthetic medicine, few situations are true emergencies. Even with vascular occlusion, like in Janet’s case, there’s typically a treatment window of 2–3 days. However, by the time Janet reached us, that critical period had elapsed, and we found ourselves in a race against time to prevent ischemic tissue damage. Fortunately, our clinic is well equipped for such emergencies, armed with a high-resolution ultrasound device and years of experience.

Filler-related vascular occlusion, with the pain of ischemia, and subsequent treatments, along with the looming threat of facial necrosis and the anxiety over uncertain outcomes, can be a daunting experience for both practitioners and patients. In these situations, ultrasound becomes invaluable. Its ability to provide real-time visualization of affected vessels and the occlusive filler enables precise, ultrasound-guided hyaluronidase injections that dissolve the filler, improve arterial spasm, and restore blood flow. Once the occlusion is treated, Color Doppler can demonstrate immediate improvement in blood flow, correlating with clinical recovery and providing reassurance to both patients and medical practitioners.

Janet’s ultrasound exam revealed several areas of blockage along the facial arteries, with adjacent filler deposits. We found areas of decreased blood flow along the jaw, in her cheek, in the temple, and at the mandibular angle, with large deposits of anechoic hyaluronic acid filler adjacent to them. We also discovered and treated severely decreased flow in the facial vein, which likely explained the unusual periorbital edema and ecchymosis. You can see one area of compromised blood flow in Figure 1.

We treated these areas with ultrasound-guided hyaluronidase injections, as depicted in Figure 2.

By the following day, Janet’s condition had shown marked improvement, and the pain had subsided. Improved blood flow in both the facial artery and facial vein can be seen in Figure 3.

Over the last several years, we have witnessed an exponential increase in the number of aesthetic treatments. However, as we keep pushing the envelope to improve our patients’ results and the longevity of our treatments, we face a growing number of complications, including overfilled faces, filler malposition and migration, lumps, chronic edema, and vascular complications such as vascular occlusion, and even stroke and blindness. Vascular occlusion, one of the most dreaded filler complications, has been the main impetus behind the introduction of ultrasound into aesthetic medicine.

This process could not have come at a better time. The use of ultrasound offers a blend of opportunities and challenges that are reshaping our profession. From mastering facial anatomy and adopting safer injection techniques to managing complications more effectively, aesthetic practitioners can harness the power of ultrasound to advance their practice and patient care, refine techniques, enhance safety, and improve patient outcomes.

References:

Desyatnikova S, Schelke L. Treatment of filler-related vascular occlusion using handheld portable ultrasound device. J Cosmet Dermatol 2022; 21:3166–3168. doi: 10.1111/jocd.15125.
Desyatnikova S, Barrera P. High-resolution ultrasound for diagnosis and treatment of filler-related septal necrosis. Plast Reconstr Surg Glob Open 2024; 12:e5630. doi: 10.1097/GOX.0000000000005630.
Choi SY, Shin SH, Seok J, Yoo KH, Kim BJ. Management strategies for vascular complications in hyaluronic acid filler injections: A case series analysis. J Cosmet Dermatol 2023; 22:3261–3267. doi: 10.1111/jocd.15990.
Schelke LW, Velthuis P, Kadouch J, Swift A. Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers. J Am Acad Dermatol 2023; 88:79–85. doi: 10.1016/j.jaad.2019.07.032.

Stella Desyatnikova, MD, is a double board-certified facial plastic surgeon, with over 20 years’ experience. She is the founder of The Stella Center for Facial Plastic Surgery and the Ultrasonos Aesthetic Ultrasound Training Center in Seattle, WA. She is a leading authority in aesthetic ultrasound research and education, committed to expanding education and awareness of ultrasound use to optimize safety of aesthetic procedures. Her research is focused on filler injectable safety and facial ultrasound applications. She is the Secretary-elect of the Dermatology Community of the American Institute of Ultrasound in Medicine (AIUM). She is also an International Expert Board Member of the Complications in Medical Aesthetics Cooperative (CMAC) and a member of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

Interested in learning more? Check out the online Advanced Dermatologic Ultrasound Course on September 7–8, 2024, with renowned faculty including Stella Desyatnikova, MD.

An Invaluable Tool in Your Practice: Musculoskeletal Ultrasound

Posted on June 25, 2024 by aium1952

Musculoskeletal ultrasound (MSK US) has emerged as a powerful tool that is advancing pediatric sports medicine. Its noninvasive nature, real-time imaging capabilities, and portability make it invaluable for injury assessment and treatment planning. Let’s delve into some key points:

Utility in Sports Medicine: The American Medical Society for Sports Medicine (AMSSM) developed a recommended MSK US curriculum for sports medicine fellows in 2010 to help guide programs towards adequate training during their fellowship to meet the requirements of competency outlined by the American Institute of Ultrasound in Medicine (AIUM) Training Guidelines for the Performance of MSK US Examination. This was later revised in 2015 and it was where the term “sports ultrasound” was first introduced to reflect the use of ultrasound by sports medicine physicians for both musculoskeletal and non-musculoskeletal indications.Since then, sports US has become nearly ubiquitous in sports medicine clinics, training rooms, and at sporting events across the country. Finally, in 2017, ultrasound training was formally added to the Accreditation Council for Graduate Medical Education (ACGME) core program requirements for sports medicine fellowships, including pediatric-based programs.
Pediatric Considerations: Skeptics may argue that ultrasound isn’t necessary for evaluating musculoskeletal (MSK) complaints in children, assuming they don’t experience the same amount of pathology as adults. However, as a pediatric sports medicine physician with a decade of ultrasound experience, I can attest that children do encounter similar MSK issues. Children exhibit both common MSK conditions (like tendinosis, ligament tears, muscle injuries, effusions, and fractures) and unique ones related to their growing skeletons (like osteochondral defects, Salter Harris injuries, apophysitis, and avulsion fractures). MSK US can play a role in evaluating all of these conditions at the point of care.
Beyond Pediatric Sports Medicine: MSK Ultrasound is a valuable tool that extends beyond pediatric sports medicine as well. It is widely used in rheumatology clinics, where it helps diagnose conditions like synovitis, arthritis, and enthesitis. Emergency physicians can quickly identify joint effusions and dislocations, full-thickness tendon tears, and fractures, influencing acute management decisions. General pediatricians can benefit from MSK ultrasound, too, and this is not just ordering ultrasounds to rule out hip dysplasia in infants. Simple questions—like distinguishing between solid versus cystic soft tissue masses and assessing joint effusions—can guide primary care clinicians. When families seek answers about their child’s condition and treatment options, especially “How can we get them back to sports safely?” time is of the essence and point-of-care ultrasound (POCUS) becomes even more important!
Interventional Possibilities: While the volume of procedures may not match clinics focused on older athletes, there are still opportunities for the pediatrician. US guidance opens the door to injections of not only joints and their recesses but also within tendon sheaths, bursa, and perineural spaces. Therapeutic injections have their obvious role in successful treatment of pathologic conditions, but diagnostic injections can also play a crucial role, especially for patients with chronic pain. Precise targeting using ultrasound ensures accurate delivery of anesthetic injectates that can help inform the clinician of the etiology of pain, which often goes undiagnosed for years in the more challenging patient scenarios.
Safety and Efficiency: Sonologists with diagnostic expertise can now confidently guide needles to precise locations, minimizing risks. Unlike radiography, which involves radiation exposure, ultrasound is radiation-free. This safety aspect is crucial, especially when discussing imaging options with pediatric patients and their families. For example, repeating radiographs or imaging contralateral sides for comparisons may be unnecessary if the pediatric clinician has POCUS in their toolbox.

In summary, MSK ultrasound is a versatile tool that empowers clinicians across pediatric specialties to make informed decisions and provide better patient care. I challenge you to take advantage of all the great MSK US resources available through the AIUM and ask yourself how you could start incorporating this tool into your practice.

Drew Duerson, MD, RMSK, is a Sports Medicine physician in the Division of Sports Medicine at Nationwide Children’s Hospital. He is also a clinical associate professor of Pediatrics at the Ohio State University. Drew is a board-certified Pediatrician with a certificate of added qualification in Sports Medicine. He also holds a POCUS Musculoskeletal certification from the Alliance for Physician Certification and Advancement.

Drew.Duerson@nationwidechildrens.org

@pedsmskusdoc

Interested in reading more about MSK ultrasound? Check out these on-demand webinars from the American Institute of Ultrasound in Medicine (AIUM):

Ultrasound in Medical Education: The Person Behind the Probe

Posted on April 30, 2024 by aium1952

In this blog post, we are going on a trip.

That’s right, let’s go on a trip back in time.

Think back to your first time picking up an ultrasound probe.

What did it look like? Who was instructing you? What were you scanning?

Did you feel confused? Lost in the little black and grey lines wiggling in unison with every movement of your hand.

Was your mind filled with wonder and awe at the ability to see right through the skin in real time? Or were you struck with confusion and pessimism? This isn’t practical. There’s no way I (or my specialty) will need to use this.

For some of us, the first time touching an ultrasound probe was a very long time ago, for others (like myself) it was just a few short months ago.

I am fortunate that my institution has incorporated ultrasound into our medical curriculum. We have had access to handheld ultrasound probes from the very first month of medical school. We are taught the physics behind sound waves and tissue echogenicity. We are encouraged to complete online modules, take ultrasound quizzes, and practice scanning as much as we can.

Hours have been spent scanning myself and my peers, trying to figure out what is what. Our faculty advisor aptly dubbed the ‘ultrasound champion’ showed us the ropes of how to improve our scanning. He was readily available, willing to explain, and quick to show what different views look like.

When he took on a different position, us students quickly found out that an ultrasound is only as good as the person behind the probe. Without our ‘ultrasound champion’ around, we quickly hit a glass ceiling, unable to elevate to the next steps in our scanning abilities.

In the ‘champion-less era,’ we have found other sources of knowledge. From online resources provided by the AIUM, YouTube, POCUS101, and SonoSim we are able to see what different views can look like. We have reached out to faculty, and they have been quick to give us bits of knowledge or take part in scanning sessions when they are available. We have collaborated with other schools in state-wide competitions, have begun scanning at student-run free health clinics, and attended AIUM conferences. We are getting better.

I view ultrasound medical education curriculum and the opportunities afforded by surrounding myself in scanning as the ultimate bridge between preclinical studies and my future in clinical medicine. The hands-on attribute of scanning mixes well with time in the books. No matter which specialty I choose, ultrasound will be a part of it as point-of-care sonography continues to grow into the scope and forefront of medical practice. While most of my ultrasound exploration has been done independently, having access to an ‘ultrasound champion’ was critical in my initial interest and excitement for ultrasound. One that I wish I still had access to.

The future of ultrasound is bright, and I am excited to share that many medical students coming up in training are extremely excited about ultrasound. We want to get better. We also need ‘ultrasound champions’ to be the catalysts that make us better.

If you are an ultrasound champion at your institution, I encourage you to keep the excitement that you felt when mastering ultrasound. You are helping your students unlock that ability.

If you have not yet taken steps to share your ultrasound skills, I urge you to share your knowledge with someone who may benefit from it, whether the person is a training nurse, a medical student like me, or even a colleague. If you have the desire to make ultrasound education a cornerstone of your practice, explore becoming the ‘ultrasound champion’ at your institution.

We need you behind the probe, showing us how it’s done so that we can be the ones behind the probe for years to come.

Brian Villa is a second-year medical student at a 4-year MD program in Florida, USA. During his very brief time in the medical field, he has taken a strong liking to point-of-care ultrasound and ultrasound in medical education. He is the leader of the Ultrasound Student Interest Group at his institution and has been included in conversations regarding ultrasound curriculum. He enjoys abdominal and thoracic ultrasound and his favorite view (as an avid fisherman) is the parasternal short axis ‘fish mouth’ mitral valve view.

Exploring the Future of Ultrasound: 5 Trends to Watch

Posted on January 9, 2024 by aium1952

Ultrasound technology has come a long way since its inception and continues to evolve at a rapid pace. As we look ahead to the near future, it’s clear that ultrasound will play an even more vital role in healthcare. In this blog post, we’ll explore 5 trends (in no particular order) that are set to shape the field of ultrasound in the coming years.

1. Portable and Handheld Ultrasound Devices

The trend of portable and handheld ultrasound devices is on the rise. In the past, ultrasound machines were hundreds of pounds, carted around on wheels, and costly to manufacture. These new, compact, and lightweight devices offer healthcare professionals the convenience of conducting ultrasound examinations at the patient’s bedside, in remote areas, or during emergency situations, and wearable devices will become part of the ultrasound tool kit. Their affordability and ease of use make them accessible to a broader range of healthcare providers, expanding the potential applications of ultrasound. I predict that, under a doctor’s care and orders, the ways in which ultrasound is used will expand!

2. Artificial Intelligence (AI) Integration

AI is revolutionizing the field of medical imaging, and ultrasound is no exception; however, sonographers and doctors are not going anywhere. AI algorithms can assist in image analysis, automate measurements, enhance quantitative imaging, and aid in the detection of abnormalities. In the near future, we can anticipate more sophisticated AI integration into ultrasound systems, which will not only enhance diagnostic accuracy but also improve workflow efficiency. AI will play a significant role in making ultrasound more accessible and reliable in terms of scanning, reading images, and delivering accurate results.

3. 3D and 4D Imaging

Three-dimensional (3D) and real-time 3D (4D) ultrasound imaging will continue to advance, providing clinicians with more detailed and interactive views of anatomical structures. This trend will be particularly valuable in obstetrics for capturing fetal development and in various other medical specialties where enhanced visualization and quantification are crucial. Expect to see more applications for complex anatomical assessments and dynamic studies.

4. Point-of-Care Ultrasound (POCUS)

Point-of-care ultrasound, or POCUS, is transforming the way medical professionals diagnose and manage patients. POCUS is expected to see increased adoption in various clinical settings, including emergency medicine, anesthesiology, primary care, and critical care. As training programs expand, more healthcare providers will be equipped to use POCUS for rapid and accurate assessments, which can lead to improved patient care and outcomes on the spot. With increased adoption, interest in ultrasound practice accreditation in this area is rising.

5. Therapeutic Ultrasound Applications

Beyond its diagnostic role, ultrasound is making great advances in therapeutic applications. Techniques like High-Intensity Focused Ultrasound (HIFU) are being employed for noninvasive surgeries, cancer treatments, and targeted drug delivery. In the coming years, we can expect to see further developments in therapeutic ultrasound, offering less invasive treatment options for a wide range of medical conditions and increasing the potential for ultrasound theranostics.

The future of ultrasound is incredibly promising with these 5 trends at the forefront of its evolution. From portable devices and AI integration to advanced imaging techniques and expanding applications in point-of-care and therapeutics, ultrasound is set to become even more integral to modern healthcare. Stay tuned as these trends continue to shape the landscape of medical imaging and patient care. We’re excited to witness the many possibilities that lie ahead for this versatile technology.

Therese Cooper, BS, RDMS, is a sonographer and the Director of Accreditation at the American Institute of Ultrasound in Medicine.

Time to Pause and Reflect

Posted on December 26, 2023 by aium1952

During my early career as an Urgent Care Physician, I worked in busy, under-served, and rural Urgent Care Centers (UCCs). At that time, Point-of-Care Ultrasound (POCUS) was not popular. I practiced in high acuity UC settings, where we would often have US machine and US tech during business hours with an on-call tech after hours, as well as CT scan, STAT labs, and IV placement capabilities. However, I was interested in learning more about POCUS – so I attended a few CME courses that taught MSK and soft tissue, led by companies like Sonosite.

After these courses, I returned to work excited and attempted to convince my medical director to incorporate POCUS into our UC workflow. My idea was rejected. As time passed and I moved to other jobs, I would again ask at each new urgent care clinic and would be met with the same response. They claimed it is cost-prohibitive and that training providers would be cumbersome.

The basic skills I learned from these courses withered away from lack of practice shortly after finishing these 2-day seminars. Years passed by, and I forgot about POCUS, having felt discouraged following many unsuccessful attempts to integrate it into my practice.

Yet, over the past 5 years, I have noticed a shift in the operation of UCCs nationwide. There has been a tendency to eliminate US and CT from UC, reserving it for emergency department (ED) patients and scheduled outpatient orders. Our UCC still maintained STAT labs and IV placement capabilities, but this shift created bigger problems. Mainly, it led to increases in unnecessary ED transfers, which led to longer ED wait times, unsatisfied patients, more UC bounce-backs, and delayed patient care. At the same time, the shortage of primary care providers (PCPs) continued to grow, and the wait to get timely appointments with their PCP remained difficult, resulting in many patients not receiving the care they needed.

When I first started practicing UC Medicine, the goal of many UCCs was to reduce ED burden through managing stable patients while at the same time reducing primary care burnout by offering primary care services to bridge the gap in access to care. Nonetheless, the lack of imaging in the UCCs has caused the urgent care world to fall short of these goals – including duplicate and incomplete workups and increased costs to patients (particularly when labs are ordered only to discover the need to go to the ED to finish the workup). Add on top of this the fact that many insurance companies will not pay for 2 visits on the same day and the lack of consistent X-ray staffing due to shortages, and it becomes clear that there is a dire need for POCUS and POCUS-trained providers in our UCCs.

Two years ago, I decided to dedicate my time to learning and practicing POCUS. Recently, I decided to do a fellowship in POCUS. I wanted to refine my skills to provide the best care for my patients. Many patients come in with presentations such as undifferentiated dyspnea. Is it CHF? Pneumonia? COPD? POCUS can help with medical decision-making and finalize safe disposition to the ED or home.

What about that popliteal DVT that you strongly suspect on your shift? It is 7:00 pm on a Friday night, and outpatient imaging will not be able to get your patient in until the following week. How would you handle this situation? Unfortunately, many times patients must go to the ED and sit for many hours to get a DVT study done. Or what about the early-pregnancy patient that comes in with some vaginal bleeding and pelvic pain? Is it an intrauterine pregnancy (IUP) or a miscarriage?

POCUS helps you treat each of these patients with clinical accuracy and speed. For example, one day in our clinic, we had no x-ray tech on shift. I didn’t want to ask the patient to travel, as they, like many in our patient population, have difficulty finding affordable and timely transport. Instead, I was able to diagnose a fracture and treat it using my hand-held ultrasound.

Another time, I was able to diagnose a shoulder dislocation and do postreduction imaging to confirm placement. I’ve been able to rule out cardiac tamponade on a young patient with chest pain and pericarditis on EKG and send him home safely. POCUS enabled me to see a foreign body inside an abscess I would have missed. The list of what POCUS has enabled me to diagnose and treat goes on: a right lower quadrant mass on a patient with suspected appendicitis, with expedited care as the ED saw these images and took him straight to CT scan; several Pneumonias on the ultrasound that were missed on chest x-ray; the ability to differentiate between biliary colic and acute cholecystitis while doing a right upper quadrant scan.

One day, a colleague came and asked me if I could do a Renal Ultrasound on her patient, an elderly female who had been seen in the ED the day before with flank pain and hematuria. She received a CT scan in the ED showing moderate hydronephrosis and a partially obstructed ureteric stone. She came to the UC 24 hours later with worsening flank pain and vomiting. My bedside POCUS showed severe hydronephrosis and a completely obstructed ureteric calculus, with the added advantage of ruling out abdominal aortic aneurysm (AAA) at the same time. We were able to transfer her to the ED and expedite her care.

I offer all of these examples to showcase POCUS’s diverse breadth and depth in urgent care medicine. Undoubtedly, it saves lives, improves patient outcomes, and reduces costs. It is time to take a step back and consider the long-term benefits of POCUS.

The money spent now on machines and training will pay dividends in the future. While it seems like a longer-term investment, it will be recouped quickly, and the benefits will continue year after year.

Amera Gaballa, MD, is an Advanced Primary Care Ultrasound Fellow at the University of Michigan in Ann Arbor.

Predicting Risk of 30-Day Readmission in Heart Failure Patients

Posted on June 13, 2023 by aium1952

Pulmonary congestion is the most frequent cause of heart failure hospitalizations and readmissions. In addition, approximately 20%–25% of heart failure patients aged 65 years and older in the United States are readmitted within 30-days after hospital discharge,^1–5 despite efforts to identify predictors of readmission for acute decompensated heart failure (ADHF), such as laboratory markers, the readmission rates remain high. Lung ultrasound (LUS), however, has been shown to be a valuable tool for assessing pulmonary congestion, providing a reliable assessment based on the presence of B-lines.

A recent study by Cohen et al⁷ evaluated the association between lung ultrasound findings and the risk of 30-day readmission among HF patients, hypothesizing that a higher number of positive B-line lung fields on LUS will indicate an increased risk of readmission. Using a log-binomial regression model in an 8-zone LUS exam from the day of discharge, the researchers assessed the risk of 30-day readmission associated with the number of lung zones positive for B-lines, considering a zone positive when ≥3 B-lines were present. According to the results from 200 patients, the risk of 30-day readmission in patients with 2–3 positive lung zones was 1.25 times higher (95% CI: 1.08–1.45), and in patients with 4–8 positive lung zones was 1.50 times higher (95% CI: 1.23–1.82), compared with patients with 0–1 positive zones, after adjusting for discharge blood urea nitrogen, creatinine, and hemoglobin.

Ultrasound image of a lung with B-lines. The pleural line is indicated by the arrow. Emanating from the pleural line are hyperechoic reverberation artifacts, which are B-lines (indicated by the star), indicating the presence of fluid within the interstitium of the lung.

This study adds to the research on LUS in patients with HF in inpatient or intensive care units and emergency departments, including studies on identifying pulmonary congestion to reduce decompensation in heart failure patients,⁷ the risk of hospitalization or all-cause death was greater in patients with more B-lines at discharge,⁸ and the prognostic value of LUS as an independent predictor of 90-day readmission.^9,10

The study by Cohen et al⁷ expands on the prior research and demonstrates the prognostic importance of more B-lines at discharge for HF patients. Failure to relieve congestion before discharge is associated with increased morbidity and mortality and is a strong predictor of poor outcomes in patients with acute decompensated HF.

By evaluating HF patients with LUS, we may be better able to risk-stratify the severity of asymptomatic pulmonary congestion on discharge and identify patients at higher risk of readmission.

References

Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation 2012; 126:501–506.
Suter LG, Li SX, Grady JN, et al. National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction, heart failure, and pneumonia: update on publicly reported outcomes measures based on the 2013 release. J Gen Intern Med 2014; 29:1333–1340.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:e240–e327.
Tavares LR, Victer H, Linhares JM, et al. Epidemiology of decompensated heart failure in the city of Niter_oi: EPICA -Niter_oi Project. Arq Bras Cardiol 2004; 82:125–128.
Cleland JG, Swedberg K, Cohen-Solal A, et al. The Euro Heart Failure Survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe. The study group on diagnosis of the working group on heart failure of the European Society of Cardiology. The medicines evaluation Group Centre for Health Economics University of York. Eur J Heart Fail 2000; 2:123–132.
Cohen A, Li T, Maybaum S, et al. Pulmonary congestion on lung ultrasound predicts increased risk of 30-day readmission in heart failure patients [published online ahead of print February 25, 2023]. J Ultrasound Med. doi: 10.1002/jum.16202.
Araiza-Garaygordobil D, Gopar-Nieto R, Martinez-Amezcua P, et al. A randomized controlled trial of lung ultrasound-guided therapy in heart failure (CLUSTER-HF study). Am Heart J 2020; 227:31–39.
Platz E, Lewis EF, Uno H, et al. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. Eur Heart J 2016; 37:1244–1251.
Gargani L, Pang PS, Frassi F, et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound 2015; 13:40.
Coiro S, Rossignol P, Ambrosio G, et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail 2015; 17:1172–1181.

To read more about this study, download the Journal of Ultrasound in Medicine article, “Pulmonary Congestion on Lung Ultrasound Predicts Increased Risk of 30-Day Readmission in Heart Failure Patients” by Allison Cohen, MD, et al. Members of the American Institute of Ultrasound in Medicine (AIUM) can access it for free after logging in to the AIUM. Join the AIUM today!

Interested in reading more about ultrasound? Check out these posts from the Scan:

Join the POCUS Revolution: Unlock the Power of Point-of-Care Ultrasound

Posted on May 30, 2023 by aium1952

A Hand-held ultrasound device scanning a patient

If you’re a fan of the AIUM (American Institute of Ultrasound in Medicine), then you already understand the importance of ultrasound technology in revolutionizing patient care. However, the emergence of Point-of-Care Ultrasound (POCUS) has taken this technology to new heights. POCUS is transforming the medical landscape, offering a sleek, affordable, and user-friendly solution that brings ultrasound imaging directly to the bedside. In this blog post, we’ll explore the advantages of POCUS over other imaging fields, share statistical data, discuss key POCUS techniques, and invite you to join us at the AIUM’s POCUS Course in Portland, Oregon, sponsored by AIUM and OHSU (Oregon Health & Science University), where you’ll discover the top 5 reasons to attend.

POCUS: Your Trusty Sidekick
POCUS is designed to be there for you when you need it the most, acting as a trusty sidekick to clinicians. With its ability to be performed at the bedside, POCUS delivers real-time answers, confirming diagnoses and guiding procedures without the need for additional appointments or waiting for results.

The Power of POCUS

Let’s explore some statistical data that demonstrates the effectiveness and widespread adoption of POCUS:

Improved Diagnosis Accuracy
According to a study published in a Royal College of Physicians journal, POCUS improved the accuracy of initial diagnoses compared to physical examination alone in various medical specialties, including emergency medicine, critical care, and primary care.
Reduced Supplemental Exams
A research article published in the Journal of Ultrasound in Medicine found that POCUS reduced the need for additional imaging studies and can reduce length of stay and imaging costs in various cases leading to significant cost savings and streamlined patient care pathways.
Enhanced Patient Outcomes
A systematic review and meta-analysis published in the Ultrasound Journal demonstrated that POCUS-guided interventions in cardiac patients resulted in improved outcomes, including reduced mortality rates and shorter hospital stays.

Key POCUS Techniques

POCUS encompasses various techniques that aid in diagnosing and guiding procedures. Some of the key techniques include:

Focused Cardiac Ultrasound (FOCUS)
FOCUS allows clinicians to rapidly assess cardiac function, detect pericardial effusions, and evaluate for cardiac abnormalities such as wall motion abnormalities or valvular dysfunction.
Lung Ultrasound (LUS)
LUS is valuable in the assessment of pulmonary conditions, including pneumothorax, pleural effusions, and pulmonary edema. It provides real-time visualization of lung sliding, B-lines, and consolidations.
Abdominal Ultrasound
Abdominal POCUS aids in the evaluation of acute abdominal pain, gallbladder disease, kidney stones, and abdominal aortic aneurysms, among other conditions. It enables quick assessment and intervention in critical situations.
Musculoskeletal Ultrasound
Musculoskeletal POCUS allows for an accurate evaluation of joint effusions, tendon injuries, muscle tears, and other soft tissue abnormalities. It assists in guiding interventions such as joint aspirations and injections.

POCUS is a game-changer, offering real-time answers that confirm diagnoses and guide procedures at the bedside. The statistical data highlights its effectiveness in improving diagnosis accuracy, reducing the need for supplemental exams, and enhancing patient outcomes. Don’t miss your chance to join the POCUS revolution and become a superhero in your own right. Register today for the AIUM’s POCUS Course in Portland, Oregon, and unlock the power of Point-of-Care Ultrasound. It’s time to level up your medical game and make a lasting impact on patient care. Sign up today!

Sources
Smallwood N, Dachsel M. Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine? Clin Med (Lond) 2018; 18(3):219–224. doi: 10.7861/clinmedicine.18-3-219. PMID: 29858431; PMCID: PMC6334078.

Amina Jaji, Rohit S. Loomba. Hocus POCUS! Parental quantification of left-ventricular ejection fraction using point of care ultrasound: Fiction or reality? [published online ahead of print December 30, 2022] Pediatr Cardiol. doi:10.1007/s00246-022-03090-w.

Kasmire KE and Davis J. Emergency department point-of-care ultrasonography can reduce length of stay in pediatric appendicitis: A retrospective review. J Ultrasound Med 2021; 40:2745–2750. https://doi.org/10.1002/jum.15675

Ávila-Reyes D, Acevedo-Cardona AO, Gómez-González JF, Echeverry-Piedrahita DR, Aguirre-Flórez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J 2021; 13(1):46. doi: 10.1186/s13089-021-00248-0. PMID: 34855015; PMCID: PMC8639882.

Arian Tyler, BS, is the Digital Media and Communications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

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