Dawning of Another Golden Age for Ultrasound

Diagnostic ultrasound is an essential clinician’s tool. And, although it often does not get the attention (such as Nobel Prizes) of its sibling imaging modalities, it is the most utilized imaging modality in the world, depending on the metric.

The reasons why ultrasound is an essential tool are likely obvious to most readers of this blog. Ultrasound is relatively inexpensive, portable, and provides real-time imaging. It can be brought to patients who might otherwise be unable to receive imaging, whether that is because of the condition of the patient or the condition of the world around them. The variety and depth of our communities of practice attest to the robustness of this imaging modality (as does this blog, in its relatively short history). Furthermore, ultrasound imaging is not a static field; new technologies and applications, such as the use of artificial intelligence for COVID-19 diagnosis, are being incorporated on a continual basis.

Kevin Haworth, PhD, Cardiovascular

The American Institute of Ultrasound in Medicine (AIUM) has played a central role in the history and promotion of ultrasound imaging due to its membership. I would argue one of its greatest strengths is that the AIUM provides a home for anyone involved in ultrasound: sonographers, physicians, scientists, academicians, students, private practice providers, and industrial partners. There are a number of other professional societies associated with ultrasound imaging, but none that cover the same breadth of topics and people.

The AIUM has done this, in part, by stepping up to the openings before it. The AIUM has embraced a variety of opportunities to make a difference in the lives of patients, including decades ago with the advent of the ‘modern’ array and continuing to more recent capabilities including bedside POCUS, telehealth, and artificial intelligence.

Is the AIUM ready to continue its role as the preeminent home for all areas of ultrasound? Is it ready to fully embrace the dawning of another golden age for ultrasound – therapeutic ultrasound?

The field of therapeutic ultrasound has a rich history stretching back decades. What separates the current era from the past is the combination of technological advancements made and the pairing of these technologies with dedicated clinicians. Furthermore, the field has been accelerating as it learns from past successes to create future ones. One of the most notable initial advances was the use of ultrasound thermal ablation of uterine fibroids, which has been available to women in the United States since 2004. A number of companies have subsequently obtained FDA clearance, the European CE mark, or other equivalent regulatory approval for their ultrasound thermal ablation devices, enabling the treatment of a wide range of conditions.

In the past decade, reimbursement has also become available for ultrasound treatment of bone metastases and essential tremor. Most importantly though, the pipeline is rich with dozens of potential applications and hundreds of clinical trials. Importantly, the mechanism of action by which ultrasound can have a therapeutic effect has grown beyond thermal ablation, with clinical trials in blood-brain barrier disruption, ultrasound-mediated drug delivery, and mechanical tissue ablation (just to name a few).

The AIUM already has a number of our basic-scientist and clinician-scientist members making great contributions, particularly within the Basic Science & Instrumentation and Therapeutic Ultrasound Communities of Practice. However, to remain the preeminent home for all areas of ultrasound, we will need engagement from the entire broad and rich swath of expertise that our full membership community has to offer. There are important questions to answer, and I do not pretend to know the answers. I am confident, though, in the ability of our community to answer them. A few of the important questions for us to consider are:

  1. Just as there has been great opportunity in bringing together ultrasound imaging expertise across medical fields, do we see similar opportunity in being a home to bring together ultrasound therapy expertise across different medical fields?
  2. How do we make our society a welcoming place for therapeutic ultrasound clinicians who might not have the deep background in diagnostic ultrasound that is common of current AIUM members?
  3. How do we integrate our existing imaging expertise in helping to advance therapy, through treatment planning, guidance, and monitoring?
  4. How do we break down some of the silos between our existing communities, particularly the more discovery-oriented communities and the more practice-oriented communities?
  5. As we have played an important role in establishing standards, guidelines, and practice parameters in ultrasound imaging, should we do the same for therapeutic ultrasound?

The fundamental question, however, is: do we want to remain to be the American Institute of Ultrasound in Medicine, or do we want to be the American Institute of Ultrasound Imaging in Medicine?

Kevin Haworth (Twitter: @kevinhaworth) is an Associate Professor of Internal Medicine at the University of Cincinnati in Ohio.

Therapy Dogs

What could be cuter and more beneficial to patients than a team of six Golden Retriever therapy dogs showing kids how to undergo procedures?

Jessie having echocardiogram-1

Therapy dog, Jessie, undergoes an echocardiogram while being comforted by ‘Mom’, who is holding her paw.

At Southampton Children’s Hospital in the UK, the therapy dogs help the pediatric patients overcome their anxiety and fear by providing support ranging from general meet-and-greet style Animal Assisted Activity visits to Animal Assisted Therapy. The therapy dogs assist in physiotherapy, speech and occupational therapy, phlebotomy services and injections, radiology investigations, and by supporting children in the anaesthetic room.

leo on mri scanner

Leo demonstrating laying down in an MRI scanner.

One of the reasons therapy dogs are so helpful is that they are nonjudgmental and take the healthcare environment in stride. They don’t cajole or persuade, and I am sure that is why the children sometimes trust them more than the people who are with them. Every parent and medical staff member is trying to get the procedure done, which is why using the dogs as a bridge between the healthcare team and the child is so very useful. As a volunteer, it has been a privilege to be able to develop this service for the hospital.

I am delighted to say that we have images and videos that enable us to assist the medical staff even when we are not there! The library of pictures and videos that the staff can show the children when they are anxious includes such things as:

  • A short film, ‘Leo goes to X-ray,’ showing therapy dog, Leo, going to the X-ray department and explaining how easy it is to have a radiology investigation, whether it is a plain film X-ray or CT/MRI scan.  (https://www.youtube.com/watch?v=Vb8kIU4y9H4)
  • A video of a therapy dog heading down to theatre after admission procedure and showing what the route to theatre looks like as well as showing the anaesthetic room.
  • As well as many adorable and helpful photos.

archie investigations collage

Archie demonstrating, from top left, a thermometer to the arm, stethoscope to the chest, SATS testing, and pulse oximitry on a paw.

You can see more in this report on yahoo! news.



Have you ever worked with therapy dogs? If so, what was your experience like? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.


Lyndsey Uglow is the Lead Animal Assisted Intervention Handler at Southampton Children’s Hospital Therapy Dogs.

Interdisciplinary Education and Training in MSK Ultrasound

In my primary specialty of occupational medicine there is a need for practical education in musculoskeletal ultrasound for both diagnostic evaluation and therapeutic interventional guidance. Incorporation of this into education has begun recently and is continuing in the specialty. A wide variety of specialties are represented in occupational medicine, including many specialists who move into the field after a mid-career transition.

Interestingly, over the last few years, clinicians have approached me and asked me to help them learn musculoskeletal ultrasound from many different disciplines outside of occupational medicine. These have included emergency medicine, orthopedics, rheumatology, sports medicine, family medicine, radiology, palliative care, and physical medicine and rehabilitation. When inquiring into why these clinicians are seeking training in this modality it seems that the consistent answer is thdr-sayeedat medical students are graduating and insisting on using ultrasound in their residency training. It would seem that many of our medical students are learning ultrasound at a rate that will outpace attending physician knowledge, exposure, and experience. Indeed, when teaching ultrasound to many of the medical students at West Virginia University as part of their medical education, I was astounded to see how proficient they were at using the machine, the transducer, and correctly identifying both normal and pathologic anatomy. It’s my understanding that many universities have included medical ultrasound into the academic curricula as a bridge to their respective gross anatomy courses and in their general clinical medical education.

Ultrasound is a modality utilized by many medical specialties for various indications. Several specialties outside of radiology, including the ones above, utilize ultrasound. Increasingly, residency programs are integrating ultrasound into their ACGME-accredited curriculum and, importantly, medical students are also learning the benefits of using the modality. It seems clear that despite the number of pitfalls, hurdles, and difficulties using ultrasound, the modality has proven to be an asset in clinical settings and has become a permanent fixture in hospital and clinical settings. The benefits of utilizing ultrasound have been well documented across many academic medical journals. I believe that medicine, as a whole, has done well to embrace the modality, however, there seems to be another vital step to take in the education arena to more fully integrate the modality into our patient’s care.

Currently, most education models for teaching ultrasound, whether it is for residents or medical students, involves grouping like kind together. Emergency residents learn it in the emergency medicine didactics. Physical medicine and rehabilitation (PM&R) residents learn it from demonstrations in their own didactics, and so on. Perhaps approaching the curriculum from a more inclusive perspective, however, would be more beneficial for residents and fellows. I, personally, had experience teaching an integrated musculoskeletal course at West Virginia University. The idea, admittedly, was born out of necessity. Physicians experienced in ultrasound from sports medicine, emergency medicine and occupational medicine created and executed a curriculum to teach musculoskeletal ultrasound and invited residents from other specialties. The interest we were able to garner quite frankly surprised me. Although the curriculum was targeted to occupational medicine residents the interest in using musculoskeletal ultrasound was widespread. Residents from specialties like emergency medicine, radiology, family medicine, internal medicine, and orthopedics attended our sessions.

While the course was a success, introducing an integrated curriculum across medical specialties posed a new set of challenges. My specialty was able to use dedicated didactic time for the education but many other specialties have disparate educational time. Many residents could not make all of the sessions and many more could not make any sessions because of fixed residency schedules. This makes coordination very difficult. As I have pondered this over the last few months I believe that educational leaders should begin to form structured educational collaborative time for activities like education in musculoskeletal ultrasound. Each discipline will be able to contribute to teaching to ensure high quality evidence-based curriculum for residents learning ultrasound. Each discipline has their individual strengths and collaboration ensures coordination and even learning amongst instructors. Integrating medicine has been a goal of thought leaders in medicine at the very highest levels and can be replicated for the instruction and training of our resident physicians.

Another option is to allow residents to attend the American Institute of Ultrasound in Medicine’s annual conference where interdisciplinary education in ultrasound occurs. This conference even has a day for collegial competition among medical students and schools. In fact, the courses are created to encourage engagement in the education and training of clinicians at all levels of training. The overall goal is to advance the education and training in this modality and hope that education leaders begin to encourage collaboration in a much larger scale thus achieving integrated medical care that provides a building block to lead to high quality evidence-based medical care for our patients, families, and communities.

What other areas of ultrasound education have room to grow? How would you recommend making changes? Do you have any stories from your own education to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Yusef Sayeed, MD, MPH, MEng, CPH, is a Fellow at Deuk Spine Institute, Melbourne, FL.