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Ultrasound Set to Transform Occupational Medicine

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There is no question that medical ultrasound is quickly becoming a valuable tool in musculoskeletal (MSK) medicine. Providers are realizing that this modality allows for quick evaluation in the office and even has a higher resolution than MRI. Research shows, for example, that scanning a shoulder to evaluate for a rotator cuff tear is faster, cheaper, and at least as sensitive and specific as ordering an MRI.

dr sayeedWhere using this modality for MSK medicine will have a huge impact is within occupational medicine.

In occupational medicine, we are tasked with providing quality care for patients while simultaneously enabling patients, institutions, corporations, and the overall health care system to save money. For practitioners, MSK ultrasound allows us to accomplish both of these goals. Widely utilized by our counterparts in European medical schools and hospitals, MSK ultrasound’s use in occupational medicine is still in its early stages in the United States. This means that occupational medicine is one specialty that stands to reap significant clinical benefits from its use.

But in order to understand the potential, and to position MSK ultrasound at the forefront of occupational medicine education, I conducted a little research.

Last year, I conducted a survey to learn how many occupational medicine program directors and residents were using MSK ultrasound and how many wanted to use it. The survey results confirmed that it was not widely used in occupational medicine residency programs. In fact, only a couple of programs use it and they do so cursorily.  The results also showed that most had a sincere interest in learning to use it, but there was not a program in place.

Since residency programs produce the field’s future physicians, I designed a multidisciplinary MSK ultrasound course to teach the basics to attendings and residents. Weekly sessions focused on specific anatomic regions to help provide a foundation for identifying pathology and improve interventional skills. This “how to” manuscript was recently published in the Journal of Occupational and Environmental Medicine.

Moving forward, I am presenting an introductory level lecture at the occupational medicine national conference (AOHC) to further demonstrate how MSK ultrasound could potentially be widely used in our field. I hope to introduce “hands-on” workshops over the course of the next few years to give the field a chance to learn this modality and implement it into practice. My goals are to see occupational medicine practitioners provide the highest standard of health care for this unique hardworking population of patients, while concurrently reducing costs for workers’ compensation claims.

What can AIUM provide occupational medicine to help further the use of ultrasound? What other areas are on the verge of being transformed by ultrasound? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Yusef Sayeed, MD, MPH, MEng, CPH, is an occupational medicine Chief Resident at West Virginia University in Morgantown, WV.

Why I Attended AIUM’s MSK Course

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In late 2014, I attended the AIUM MSK ultrasound course that was held at the USOC facilities in Colorado Springs. Why, you might ask? Well, here are four reasons I did.

  1. Focus—I do a lot of MSK ultrasound (I have my RMSK and my practice is AIUM accredited) but I do not see a lot of hand and wrist. Since the focus was going to be on upper extremity I felt that this would be a chance to get a good review of hand, wrist and elbow.
  2. USOCKiller faculty—Jay Smith, Lev Nazarian, Tony Bouffard and Jon Jacobson were all on the schedule. Combine them with a limited number of attendees and I knew I would get to interact with them on a more personal level.
  3. Great format—The way the content was structured really appealed to me. I like how we had a lecture, followed immediately by a live scan and then the ability to scan patients. It was excellent and really brought the lecture material right into practice.
  4. Location and price—I had never been to Colorado Springs, much less the Olympic training center. And when I looked at how focused the course was as well as the faculty, I felt the price was very reasonable—especially with the option of staying on site.

For me, the thing that stood out most at the course was getting an appreciation for scanning the scapholunate ligament (SLL). My scanning preceptor was very adept at showing us how to visualize the ligament and how to easily locate it. When I went back to the office and actually had an SLL injection, I was able to do it effectively and get my patient good relief.

I hope that if or when the AIUM does this course again, or another MSK course, they keep the number of participants limited and the topics varied. At some point, I think the course could become stratified so that whether you are at a beginner, intermediate or advanced level, you can participate and learn. Personally I’d like to see a course focusing on the hip and spine with injections.

All in all, given the hosts, the course faculty, the limited number of attendees and topic scope, the price and location, this was one of the best MSK ultrasound courses that I’ve attended.

What’s the best course you have attended? How can AIUM make its courses better? Have you heard about AIUM’s newest MSK Course? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Amadeus Mason, MD, is Assistant Professor of Orthopaedic Surgery and Family Medicine at Emory Sports Medicine Center in Atlanta.

5 Questions with Dr Lee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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