My name is Barbara, and I have been an Ultrasound tech for more than 30 years now. Part of my job for the last 25 years has been to get and keep our labs accredited. We recently changed the accrediting body to the American Institute of Ultrasound in Medicine (AIUM). Our initial accrediting body has always been a pleasure to work with, but inside I felt that the AIUM must be more in tune with what our concerns are, being it is strictly ultrasound.
We changed up 2 years ago, and wonderful things started to happen. First, we added more heart views, as, before, only the 4-chamber view was required. We changed that. Many of our younger techs were not proficient with all of the views, so we all pulled together. Our boss let us set up multiple hands-on training sessions from the older, more experienced Sonographers. He let us have as much time as we needed. It was beautiful to watch everyone working together.
Also, as a requirement of our Diagnostic Breast accreditation, every tech in our department got Breast certified; at least 15 techs needed to. Which everyone did willingly. The Radiologist now having to get 15 credits in breast ultrasound, did that willingly too. Everyone was on the same page.
Then what is even more astonishing is our boss came to me and asked if I would set up a quality assurance program. He realized that our exams are so tech-dependent that the techs need a resource to help them grow. And in a busy department, he wanted to make sure they all get what they need to be the best they can be.
As a part of that quality assurance program, management has allowed me to take time in my schedule to review a Sonographer’s ultrasound images. I review at least 30 exams to see a pattern or determine what the sonographer may lack. I then go over my results with the individual tech about image quality, image technique, etc. And, if we noticed the tech may need help in a certain area, we set up a one-on-one or place that tech with a tech that is more experienced to build the less-experienced tech’s confidence and skills.
I am so proud of our management and staff…Thank You, AIUM, for being a catalyst for such good things!!!!
Barbara A. Fennen, RT(M), RDMS, RVT, is a Sonographer at Beebe Healthcare in Rehoboth Beach, DE.
Beneath the paper drape of the “2:30 OB Confirmation” lies your next patient. Despite the application of the ultrasound study performed, a variety of stressors wreak havoc on a patient’s mental state prior to examination. The impact of what we say and how we say it, or the very lack of it, can shape a person’s view of testing, staff, or even healthcare as a whole. Yet, how much of an emphasis in ultrasound training is placed on effective communication? Especially in obstetrics where early pregnancy loss is prevalent, a blank stare at the monitor and averted eyes feels disconnected and insensitive. Let’s ask ourselves:
How do we, as ultrasound providers, communicate with our patients?
Do we attempt to provide comfort or empathy when needed?
How important is this interaction to our patients?
We owe it to quality patient care to take a deeper dive.
In settings where our patients show fear, stress, or grief, what’s your dialogue? How should it look and sound?
Perhaps your patient, waiting nervously under the drape, presents with a poor OB history. Performing an ultrasound examination should encompass more than the stoic mechanical bedside manner. We should engage with the person behind the diagnosis code.
We see it often in OB. Despite reassurances of last week’s scan and normally-rising labs post early spotting, the patient leaves her appointment only to consult Dr. Google where she absorbs every related link about bleeding in pregnancy from previa to placental abruption. It’s been the L O N G E S T week of her life, and she’s sure fate will deliver yet another D&C instead of the child she desires. Miscarriage is the kind of trauma that leaves a woman emotionally scarred and fearful that history will repeat itself. It’s imperative we contemplate the real trepidation some patients feel for their examinations—and act accordingly.
For the brief time a patient resides in our care, we sonographers control the environment. We drive the equipment, manage the time, and guide our patients. It is completely within our power to greet them with warmth and direct eye contact, to adopt a caring tone in our explanations, to ensure comfort in our care, and to assure answers for their questions—where we can.
It’s a fine balancing act, isn’t it? …A tightrope walk between what we sonographers can share with an inquiring patient and what we cannot. Though protocols vary, we all surely must learn what information we are allowed to impart. Precisely how we convey it is up to us. After all, our patients must disrobe before a perfect stranger who is not their physician; in turn, we must overcome the propensity for a swift robotic contest against the clock to be more attentive. We may not manage a patient’s care, but for a short time, we are a patient’s provider and caregiver. The interchange with our patients is as much an integral part of our job as is concise reporting.
Effective patient communication should be a cornerstone of every curriculum and commence as early as learning sagittal versus transverse. Every veteran sonographer who relishes the confidence of cultivated skill and experience began the same way. Typically, navigating this technology for most students requires a long learning curve to perform it well and accurately. It’s quite easy for the initial focus to lie with capturing textbook images, not connecting with the patient. Learning appropriate and competent dialogue is as imperative as exam protocol. The new sonographer must observe and mimic this personal interaction before the first steps beyond the classroom.
Conversely, the skillful sonographer, buried in the demands of a hectic patient load, may lose the tendency over time to prioritize this communication. Juggling the demands of a full schedule with urgent add-ons and after-hours call, we sometimes end up fanning the flames of burnout where a slide into the hurried robotic pace of patient-in, patient-out feels unavoidable. Don’t lose sight of the importance of your work and who depends on you. Every patient you scan lies on your table, and your’s alone. We are each responsible for the level of quality care we provide.
Now, examine your own daily patient interactions. Are they mechanical and rushed? Or do you take the time to employ earnest conversation? Do you attempt to allay fears or offer an empathetic tone when needed? Do you extend the care you would want, need, and expect if on the receiving end of healthcare? I challenge each of you to put forth the very same degree of consideration you’d like for your mother, your sister, your daughter, yourself…if the white coat fear was your own, if the anxiety of a test result was your own, if the pregnancy loss was your own. The appreciation our patients show can mystifyingly renew a sense of purpose in our work today and fuel our career tomorrow.
So, what’s your dialogue?
Sandra M. Minck, RDMS, is the creator of UltrasoundUnwrapped.com and @ultrasound_unwrapped on Instagram, a resource for accurate ultrasound information for expectant parents. She is the author of Ultrasound Unwrapped: A Pregnancy Image Guide, soon to be published.
Interested in learning more about communicating with patients? Check out the following posts from the Scan:
Eighty percent (80%) to 90% of sonographers and ultrasound providers across disciplines indicate they experience pain from musculoskeletal injuries, 1–3 which is a much larger percentage than in just about any other specialty within healthcare. Work-related musculoskeletal disorders (WRMSDs), however, frequently go unreported and can lead to a career-ending injury, so an alliance of 8 organizations* have come together to create the WRSMD Grand Challenge with the intent to stop work-related musculoskeletal disorders resulting from the performance of diagnostic medical ultrasound.
As a part of this alliance, Dr Yusef Sayeed recently spoke about this topic, encouraging us to help promote our specialty, to progress, and to take care of this work-related issue at the very onset before things become pathology. Unfortunately, one of the largest problems within the sonographer community is official reporting of the issue and transparency. Sonographers most commonly don’t report their injuries because they fear it could cost them their job, or they are afraid of the stigma doing so could cause; this reasoning also applies to ultrasound providers and fellows, as well as is true within the healthcare field overall.
Of those injuries that do get reported, the Department of Bureau and Labor Statistics reported that the vast majority of the lost-work-time occurrences in 2016 resulted in major lost work time (11 or more days) with a median of 13 days of lost work time.
The risk factors for work-related musculoskeletal disorders have been identified as the following:
Awkward posture
Repetitive movements
Pinch grips
Wrist flexion and extension Placement of the monitor/screen
Musculoskeletal disorders are cumulative trauma disorders and develop gradually over time from repetitive activity (micro tears in the anatomy). To reduce these occurrences, alternate the side from which you scan; always standing on the right puts your right side at risk because of the repetitive motion. Step around rather than reaching across obese patients, because reaching results in you being most abducted, which also predisposes you to injury. And avoid holding the transducer in a pinch grip. In additiona, when your shoulder is abducted and your elbow extended, this puts a great deal of repetitive force on both the cervical spine as well as the shoulder joint.
Employers of sonographers also need to be cognizant of the risk factors they can prevent, such as performing more than 100 scans per month, getting less than 10 hours of rest between shifts, requiring 13 or more hours per day on shift, and night shifts (in general, night shift workers suffer more injuries on the job and have worse metabolic outcomes, ie, they suffer cardiac disease, have higher rates of CVA and MI, etc). Current business models tend to mean more scans and less time between them so sonographers are predisposed to higher rates of work-related injuries. Employees should also be able to report injuries without reprecussions. Another way employers should mitigate risk is by providing personal protective equipment such as cable straps, ergonomic tables, ergonomic chairs, etc.
Changes made in manufacturing would also help, such as making screens mobile and able to rotate and creating lighter-weight and wireless transducers, etc.
To make sonography a more sustainable profession, we need to ensure WRMSD education reaches not just sonographers and their employers but also regulatory agencies and the medical community as a whole. We need to:
Increase awareness, education, and transparency;
Understand risk factors;
Provide tools to prevent and reduce injuries, including forms of hazard control;
Engage in research to better understand occupational repetitive motion injuries; and
Advocate for our colleagues, patients, and friends.
View Dr Sayeed’s full webinar on YouTube to learn more about the injuries that can be a result of these risk factors:
Sayeed Y, Sully K, Robinson K. Work related musculoskeletal injuries in sonographers and providers: the Grand Challenge. Ultraschall in Med 2020; 41: 1–10.
* The WRMSD Grand Challenge Alliance of Organizations:
American Institute of Ultrasound in Medicine (AIUM)
American Registry for Diagnostic Medical Sonography (ARDMS) and Inteleos
American Society of Echocardiography (ASE)
Intersocietal Accreditation Commission (IAC)
Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT)
Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS)
Society for Vascular Ultrasound (SVU)
Society of Diagnostic Medical Sonography (SDMS)
Interested in learning more about preventing musculoskeletal injuries? Check out the following posts from the Scan:
2020’s trials seem to have come on like a freight train; full steam ahead with no signs of stopping. Australia was still burning when we first heard stories of a novel virus with pandemic potential in Wuhan, China. Numbers and other details seemed to change daily. Weeks went by as we watched world news intently, taking note of the infection rate and death toll, all the while steeling ourselves for a possible outbreak at home. As much as we tried to go about our daily lives, Wuhan and the virus was never too far from our minds. Was this virus airborne? There were still so many unanswered questions, but one thing was certain; COVID-19 was spreading like wildfire and it was only a matter of time now before we would be on our own front line.
Sonographers and other medical professionals soon began deployment into COVID wards in our own hospitals: areas that had been sealed off and outfitted as negative pressure cohort units to treat the infected patients. Then the deluge of daily updates and dizzying policy changes began as we tried to keep up with CDC guidelines. Rumors surfaced of limited PPE (personal protective equipment) supplies. Only doctors and nurses needed n95s? Regular procedure masks were fine for everyone else? Surely that was incorrect. Surely they knew what kind of prolonged contact sonographers have with our patients? X-ray was making contact with every patient under investigation (PUI). CT was scanning countless chests. Worries intensified as we all tried to navigate this new reality.
I’ll never forget my first assignment in the cohort. Only one other sonographer in my department had gone into the cohort at that time. He relayed seeing 3 morgue carts lining a hallway on his first trip inside. I thought about that often in the days that followed and I knew my turn was coming. How would I handle that? Some of our respiratory therapy (RT) and interventional radiology (IR) colleagues had tested positive by this time. I thought about my little boy. I saw news coverage of doctors and nurses who were self-quarantining after their shifts to decrease the potential spread to their families. I didn’t have that option as a single mother.
Finally, it came: my first COVID+ request. I told myself it would be fine. I just needed to be brave, be safe, and stay alert. I’ve never been to battle but having the media images in my mind and knowing the death toll numbers, I imagined this is what it might feel like on some small level. I thought about the PPE shortage and the rumors that we wouldn’t have access to n95s. I steeled my nerves and walked one foot in front of the other with Apollo (my LOGIQ E10). I arrived outside the cohort and was immediately greeted by the plastic sheeting that sealed off the unit. I found an anteroom with shelves overflowing with supplies. A lovely volunteer helped outfit me with everything I needed: a fresh n95, a surgical mask to go on top, a contact gown, shoe covers, eye protection, and a scrub hat. We exchanged nervous chatter for a moment as she gave me a once over to make sure I was ready. She opened the door and I exhaled as I walked inside.
As I made my way to my first patient, I noticed things were definitely different. Physicians and nurses donned full respirator masks, patient information was written on the room windows so staff could see information such as code status from the hallway, and iv poles with extra tubing sat outside of patient rooms so nurses could adjust pumps without going inside. I also learned that doctors were either doing virtual or modified rounds with one MD per team going into the patient’s room while the rest stayed outside. One came in during my 30-minute exam. As I stood hip-to-hip with my patient, he stood at the foot of the bed, asked the patient a few questions, and was gone in about 2 minutes. It struck me how much extra caution was being taken for doctors and nurses to limit their exposure times.
Some other things in the cohort looked like business as usual. I saw radiographers and cardiac sonographers going about their usual work. I saw food service delivering meals. I saw housekeeping working to stay on top of the mountains of doffed contact gowns and other garbage. Everyone was working individually on this front line for a common goal: our patients. Yet, as I arrived home that day and turned on the news, I was once again told by the media that nurses and doctors are the essential workers in this pandemic. While I absolutely believe nurses and doctors deserve every ounce of recognition they receive, I sometimes think people forget that it takes a team to deliver excellent patient care. I was fortunate enough to be able to share my experiences with Alison Bowen of the Chicago Tribune recently in the hopes of illuminating just some of what we do in a day as Diagnostic Medical Sonographers.
My first patient had a seizure during my exam that day. As I approached my second patient’s room to perform a liver Doppler, a doctor sitting outside of the room informed me the patient had just passed away. My third patient was about to receive a Foley catheter and was extremely nervous. Her nurse asked me to help assist before I started my ultrasound. The patient was still very nervous so I went to the hallway to find extra help. I asked an employee there if she wouldn’t mind coming in and holding the patient’s hand. She looked behind herself and then back at me before stating, “I’m just EVS [environmental services] but I’m happy to help if it’s OK.” She donned a gown and jumped right in.
Angela Huang, BS, RDMS (AB,OB/GYN,PS), RVT, is a Diagnostic Medical Sonographer for a large research hospital in Chicago. She attended DePaul University for undergraduate studies where she majored in Biology. Huang went on to Sonography school at El Centro College in Dallas, Texas. Now, she has a 10-year-old son who keeps her laughing and they love to travel and explore.
Interested in learning more about COVID-19? Check out the following posts from the Scan:
CLEAR!, by David P. Bahner, MD, FAIUM, FAAEM, FACEP
It is been almost 5 weeks since I got infected with SARS-CoV-2 (also known as COVID-19), my life-changing experience.
The day all started, during my night shift, I started with low-grade fever, chills, and myalgia; I did not doubt for a second that I had to have the test for SARS-CoV-2. That same day, most of my mild COVID-19 patients had these same cold-like symptoms, but some of them did not have a known epidemiological contact. Without time to have any other tests done, laboratory or X-ray, I self-quarantined at home waiting for the result. And finally, it came in the midst of the night; I received the “positive”.
In the morning, as more symptoms started to appear, headache, diarrhea, anosmia, ageusia and dry cough, it was a relief to have my hand-held ultrasound device at home. With the rush, I even left my oximeter, which measures heart rate and blood oxygen levels, in my hospital locker.
There is now growing evidence regarding the imaging findings of COVID-19, but at that time, the only studies were performed via CT scan and X-ray. With my ultrasound probe, I scanned following 8 zones (2 anterior, 2 lateral of both hemithorax) plus posterior lobes. I felt relieved (didn’t last long) to see there was a normal A-line pattern. More relief came when at some point I had a dull but constant right lower abdominal pain with normal appendix and no hydronephrosis on ultrasound.
What impresses most about this disease is its dynamic pattern, with sudden changes during the evolution. As my symptoms waxed and waned, so did my lung ultrasound, probably in a different manner than I would have expected. As the disease progressed, I saw all the possible lung findings, from the initial posterobasal scattered B-lines, to small pleural effusions, irregular pleural line, coalescent B-lines, and finally subpleural consolidations, especially in posterior and lateral areas. My personal impression was that I wasn’t feeling worse when I had more B-lines, but when the subpleural consolidations started to appear and spread. Each time I had new subpleural consolidations, there was a worsening in my symptoms coming: more myasthenia, cough, and diarrhea. After the second week, the subpleural consolidations were replaced by coalescent and scattered B-lines. Following that, the irregular pleural line persisted longer.
Surprisingly, during the third week, things started to worsen again, and on ultrasound there was a big consolidation appearing in one lobe, that was my sign for a therapy shift towards antibiotics.
My personal feeling is that consolidations are more reliable than just the number of B-lines, and correlated better with my symptoms. Actually, after 3 weeks from the symptom onset, after recovering and testing negative for SARS-CoV-2, I still had several areas with scattered and coalescent B-lines, as well as thickening of the pleural line. We have to be more flexible and take into account other parameters (i.e. oximetry), rather than rely solely on the number of affected areas on ultrasound, to compose the clinical picture, and influence the management.
As I remarked before, what impresses me most about this disease is the ultrasound dynamism. After having recovered, I still had new areas of thickening of pleural line that appeared in the back (asymptomatic) for the following week (4th), and almost 5 weeks after, I still had one plaque. And after 5 weeks, I am still surprised to have unnoticed findings, such as an asymptomatic pericardial effusion.
As a firm sonobeliever, I found it extremely useful to monitor my disease for sonographic progression and or resolution, and quickly detect complications. After this experience and having returned to work, I would have no excuse to irradiate my patients before scanning them, in the same way I went through.
Definitely, this experience was the best lesson I could have before returning to the trenches.
Yale Tung Chen, MD, PhD, is an associate professor at Universidad Alfonso X El Sabio, in Madrid, Spain. He was diagnosed with COVID-19 and shared his symptoms and ultrasound images each day on Twitter @yaletung. Follow his thread at #mycoviddiary.
Interested in reading about topics that could be of interest during the COVID-19 pandemic? Check out the following posts from the Scan:
The Scan has been a home for all things ultrasound, from accreditation to zoos, since its debut 5 years ago, on February 6, 2015.
In its first 5 years, the Scan has seen exponential growth, in large part due to the hard work of our 110 writers, who have volunteered their time to provide the 134 posts that are available on this anniversary. And it all began with Why Not Start? by Peter Magnuson, the AIUM’s Director of Communications and Member Services, who spearheaded the blog’s development.
In honor of this 5th Anniversary, here are some of your favorites:
“Lie down on your back, your elbow is about to get a lot of gel on it,” said the proctor during our most recent AIUM headquarter course. As staff, we often have to step in and assist at meetings in ways we had not planned. This moment was not any different, but we do it because we want to understand and enhance the attendee experience. Turns out I have a “beautiful” elbow and yes, some of you beginners are pressing too hard.
As I had my second joint scanned, I thought, what a cool experience; my body is going to help advance the safe and effective use of ultrasound. I found myself offering to volunteer any chance I could, having my elbow, ankle/foot, and shoulder scanned in the end. I listened, watched, and learned as attendees explored.
So why am I telling you this? As a program/meeting planner, it was valuable for me to see things from a model’s perspective:
You really should wear comfortable clothes.
Gel really will get all over you.
Talking to the attendee can help them learn.
Here at the AIUM, we offer great opportunities for models to get involved at our annual meeting and courses, but for those of you who have not gotten on one of those exam beds as a model in a while, I encourage you to do so. Everyone learns on that bed; ultrasound grows on that bed; your future sonographers and physicians need you on that bed.
We have a unique opportunity to provide true hands-on experience in our field and I encourage you to support that in any way you can. Who knows, you may learn a thing or two about your body as well. #snappinganklevictim
Have you ever been a model for a hands-on ultrasound course? Share your experience below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.
Jamie Parreco is Director of the Events and Continuing Education Services department at the AIUM in Laurel, Maryland.
Most of us who do ultrasound commonly use the disclaimer that “the study is suboptimal because of the patient’s body habitus” (we stay away from the word “limited” because this word has specific billing implications). This phrase conveys to the referring physician that we are not getting the pictures we hope to get because of something we can’t control, namely the patient’s size. No matter how we tweak the transducer frequency, adjust the time-gain compensation curve, or simply press harder we cannot achieve optimal image quality.
Sometimes, however, we are either pleasantly or unpleasantly surprised. A thin individual may have soft tissues that are difficult to penetrate, leading to an image of suboptimal quality.
Conversely, a patient with high body mass index may turn out to be a breeze to scan. Clearly, there is something more than simply patient size that is at work here. After all, echoes on ultrasound are created at interfaces between tissues that differ in acoustic impedance. A larger patient with relatively homogenous subcutaneous tissues (fewer interfaces) may reflect and scatter the beam less than a patient whose tissues are composed of a more varied mixture of fat, fibrosis, and/or edema (more interfaces).
When people consistently look great in photographs, we call them “photogenic”. The implication of this word is that somehow the camera loves the subject so much that their still image “overachieves” compared to the expected output. When you think about it, that may be a subtle insult, but it is usually used as a compliment. Conversely, a person we find attractive may, for reasons that are unclear, not be at their best in photographs.
In light of the above, I would like to coin a new word, “sonogenic”. A sonogenic person is one who transmits sound so well that their ultrasound images consistently exceed expectations. A patient that frustrates us because their images are of lower quality than expected would be characterized as “non-sonogenic”.
Using this word can potentially facilitate communication. The sonographer could say to the reading physician: “Sorry for these images; the patient wasn’t sonogenic”. The physician’s reports can become shorter: “The study is suboptimal because of patient’s body habitus” becomes “the patient is not sonogenic”. The noun form would be “sonogenicity” (yes, “photogenicity is a word”). A simple grading system may even become part of the ultrasound report, i.e., sonogenicity is above average, average, or below average.
In conclusion, I hereby propose that the word “sonogenic” be added to the formal ultrasound lexicon. What do you think?
Would you use the term sonogenic? Do you have any other suggested new terms that could better describe an aspect of an ultrasound examination? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.
Levon N. Nazarian, MD, FAIUM, FACR, is Professor and Vice Chairman for Education in the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.
How many of you entered into the career of a diagnostic medical sonographer with the intent of eventually retiring and living comfortably after 20+ years? Me too! The reality is very few of us make it to 10 years, let alone 20 in this field. Without giving you copious amounts of statistics and a personal sob story that I am sure most of you can relate to, the fact is we are all incredibly prone to injury. After just 6 years of scanning, I have shoulder, back, elbow, and wrist pain daily. After sending out my own personal survey, I was able to verify that almost 100% of you can relate to this discomfort.
For the past 5 years, I have been a huge fitness advocate devoting my time to bettering myself and those looking to live a healthier lifestyle. Just a few weeks ago it clicked; why not incorporate my love for fitness into my love for sonography?! I took on the challenge by recording some of my upper body, specifically shoulder workouts that I had been doing lately in the gym. With increased BMIs, shorter scan durations, and increased patient loads, we need to take care of ourselves first and foremost. I feel incorporating physical training and stretching would prolong our careers and our quality of life.
Some of you are probably wondering how you can incorporate working out after a busy day, but when you make small changes daily, you do get stronger. Strength, in turn, makes scanning easier and ultimately decreases your pain. My arms are twice the size they were when I started scanning 6 years ago. Through yoga, stretching, and these upper body workouts my body now has a way of protecting my joints that are most susceptible to injury.
Can you believe the solution to our injuries has been to find a new career!!? I did not go to college for 4 years and work my butt off to just “find a new career.” Let’s work together on improving our own personal health and let’s start with these shoulder strength exercises.
I challenge you to find 3 days a week to do the following exercises seen in the linked video and listed below:
Resistance band warm-ups
Bicep and hammer curls
Pulley lateral raise
Bent over lateral raise
Barbell upright rows
Machine shoulder press
**Start with 10 repetitions and 2 sets of each exercise and increase those numbers each week.
I absolutely love posting my fitness journey, including great workouts that will have you thanking me later. You can find me on Instagram: @_sonographer_squats_ or by email: shaunadittl@gmail.com. Below, I posted my shoulder workout that will help you through the list I mentioned above, as well as the link to my survey.
Do you do any strength training to prevent injuries? What exercises would you recommend? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.
Shauna Gebelle, BS, RDMS, RDCS, RVT, is a Perinatal Sonographer in San Diego, California.
How many of us began our sonography journey thinking about the number of callbacks that we would log per shift, the number of patients that we would scan in an 8-hour day, or, even worse, the number of career-ending ailments that we would amass? Zero; we didn’t.
We saw ultrasound as a way to contribute to something bigger than ourselves.
The complex, yet simplistic, science of sound drew us to the field. Looking at the screen and seeing the images come to life was fascinating, and being the first to see presenting pathology while shedding light on the diagnosis mesmerized us. The thought that even after 20 or 30 years in the profession we would encounter images of structures that we’d never seen before was enticing, and the opportunity to be a life-long leaner was thrilling.
Patient interaction and our role in their medical experience appealed to us. Not too much, not too little, but just the right amount of patient care time that allowed us to interact with them and leave a positive imprint on their journey. We imagined we would sit by their bedsides, walk them casually back to the exam rooms, and listen as they shared.
Our patients would come first.
Instead, too often, we found ourselves in the middle of a never-ending battle between cost-effectiveness and patient satisfaction reports. We logged more hours of callbacks than we ever thought possible, sometimes having difficulty even finding the correct key to open the ultrasound office door. We strived to create the profession that we had imagined within the confines of the variables that we’d been given. We did the best that we could, often to the detriment of our own bodies.
And, somewhere along the way, we forgot the wonder of our profession.
About 10 years ago, I had the opportunity to participate in my first overseas medical trip. A group of physicians and a few sonographers, with portable machines strapped in backpacks, were intent on sharing sonography with some of our peers an ocean away. It was during this trip that I saw the purest form of ultrasound come to life. We had one of the simplest of machines and the most basic of lectures and yet they came from miles to learn. The patients sat all day in the heat waiting for the opportunity to have an ultrasound scan. I witnessed ultrasound identifying and explaining pain that had existed for years. I saw tears of relief, joy, and despair as people received answers that changed their lives.
A few years later, I was able to return to the same place. I fully expected to find that they had not utilized our lessons on sonography to their fullest. Instead, our previous pupils greeted us with dog-eared textbooks, mastered skills, and the desire to know more! The seeds of education that we had planted had flourished as they realized the potential ultrasound held for their rural clinics. It offered the ability to quickly investigate and diagnose and you could see the wonder of ultrasound that we had once experienced reflected in their eyes.
Seven years ago, my family and I had the opportunity to move to a developing country. Living in the second-poorest country in the western hemisphere with limited medical availability, I now see every day the wonder of our profession come to life. All the benefits of ultrasound that we learned as students, that are often taken for granted, are the benefits that allow lives to be changed every day.
Portability – I can scan in a makeshift clinic, under a tree in a field, or in someone’s handmade shelter while they lay on the floor.
Inexpensive – Portable machines are relatively inexpensive and diagnostically sound, making them perfect for short-term trips or as gifts to native physicians.
Quick – Within minutes, we can scan and find answers to problems that have hindered the livelihood of those who are sick and in pain. One of my first patients was an OB patient who had been in labor for several days without any progress. A quick scan revealed placenta previa.
Relatively Safe – Without the worry of radiation and chemicals, ultrasound, when utilized by those who are qualified, provides a safe method of imaging.
True, my exam room isn’t exactly ergonomically correct and there are times that chickens and roosters run underfoot. I’ve had to prop the machine on a rock and scan in the brightest sun of the day. But I’ve also witnessed a mother’s face when she sees her baby for the very first time without me having to operate under the time constraints of efficiency. I’ve held a father’s hand as he realized that the pain he’s had for years isn’t the cancer he so greatly feared but a simple fix. I’ve scanned at the bedside of a daughter who lay dying without any medical options, and I fall more and more in love with our profession every single day.
Experience the wonder of ultrasound again.
If given the opportunity, I encourage you to participate in a medically related trip or volunteer opportunity. You will see firsthand how our profession and our images impact the world one life and one scan at a time. You don’t have to move permanently as we did to a developing country. Opportunities also abound in your local community from volunteering your time as a clinical instructor to scanning for local centers. Expand your horizons and allow yourself to experience the wonder of ultrasound again.
How have you seen ultrasound incorporated into medical care in other nations? Do you have an ultrasound story to tell? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.
Tammy Stearns, MS, RT(R), RDMS, RVT, FSDMS, is Director of Women’s Ministry and Sonographer for Project H.O.P.E. in Managua, Nicaragua. She is also the President of the Society of Diagnostic Medical Sonography and an adjunct professor of Diagnostic Medical Sonography at Adventist University in Orlando, Florida, and a sonographer consultant for Heartbeat International. She is also the author of “Know Hope” and “Living Worthy”.
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