Workplace Conflict in Medical Imaging

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I’m going to tell you all a secret: I enjoy conflict.

No, I don’t enjoy creating conflict, and I certainly don’t enjoy being involved in conflicts with peers or my students. But I love studying it, mainly “why” conflict happens and how it impacts our organizational systems and daily interactions. Perhaps I’m naïve and hold an idealistic view that if we solved specific problems, the world would be run more effectively, and people would have more time to improve themselves and their environments. Wild, right?

I began looking into workplace conflict in hospitals in 2019 while shopping around for a dissertation topic, combining my knowledge from two fields of expertise: Vascular sonography and conflict resolution. Little did I know this task would become Herculean in scope as I quickly discovered how allied health professionals were marginalized in literature exploring conflict in hospitals.1 I found this odd and wanted to dive into this topic, puzzled by this literature that should have known conflict did not occur in a vacuum. Additionally, all the unresolved conflicts in healthcare would inevitably spiral out of control, leading to systemic conflicts that were much harder to resolve.

Many folks use the word “systemic” without understanding complex systems theory.2 Have no fear; I won’t bore you to tears with an explanation of systems theory and the differences between open and closed systems. However, I will explain that not only are you a system, but our healthcare professions are systems, our medical imaging departments are systems, and hospitals are systems. Sometimes, these systems work in harmony, but sometimes, they do not function as intended, leading to two types of social conflict: interpersonal and interprofessional.1 These conflicts demoralize hospital staff and probably impact patient care delivery from physicians, nurses, and allied health professionals who could be suffering from stress and burnout.1

We are all familiar with interpersonal conflict; it is unavoidable and, in many ways, necessary for personal growth. It is interprofessional conflict that should warrant more attention, particularly in hospital settings, as there is a tendency for healthcare professionals to be tribal in their group behavior, meaning they stick with their “own” and have an in-group preference. Medical imaging departments are not exempt from this phenomenon.1 Based on existing literature exploring conflict in hospitals,3,4 most reported conflict is interpersonal and intraprofessional, meaning the conflict most often occurs between peers, eg, nurse versus nurse. Interprofessional conflict reported in the literature also involved nurses versus physicians and occasionally involved allied health, including medical imaging professionals.1

The origins and antecedents of conflict within medical imaging are multifactorial: They combine personal factors specific to individuals with work-related issues exacerbated by high-stress, unpredictable work environments.1 Interprofessional conflict is particularly troubling as it suggests a difference in professional values between professions or a divergence of interests between patient care and the need to generate revenue.1 In those situations, a phenomenon known as “dual agency”1 may explain some interprofessional conflicts as medical imaging professionals struggle to advocate for patients while also serving the interests of their employers. This does not explain all of the interprofessional conflict, but it does suggest a need for medical imaging professionals to consider their roles in the larger healthcare system and if they are truly serving the best interests of their patients.

So, how do we address workplace conflict in medical imaging? Unfortunately, I see no “one size fits all” solution, but I propose a template for resolving many issues that contribute to conflict: Dispute systems design.5 Dispute systems design is a tailor-made analysis of a unique, conflict-prone environment that could identify problem elements within the system and provide opportunities for long-lasting resolution. Managing conflict is a misnomer, as the key to lasting conflict resolution is collaborative conflict resolution between conflicted parties.6 I am confident that introducing dispute systems design into hospitals and medical imaging departments can elicit many positive changes, potentially reducing burnout and staff turnover.

References

  1. Moody RC. Medical Imaging Professionals Experiencing Workplace Interprofessional Conflict: A Phenomenological Study. Davie, FL: Nova Southeastern University; 2023.
  2. Meadows DH. Thinking in Systems: A Primer. White River Junction, VT: Chelsea Green Publishing; 2008.
  3. Almost J, Wolff AC, Stewart-Pyne A, McCormick LG, Strachan D, and D’souza C. Managing and mitigating conflict in healthcare teams: an integrative review. J Adv Nurs 2016; 72:1490–1505. doi:10.1111/jan.12903
  4. Kim S, Bochatay N, Relyea-Chew, et al. Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review. J Interprof Care 2017; 31:282–290.
  5. Rogers NH, Bordone RC, Sander FE, and McEwen CA. Designing Systems and Processes for Managing Disputes. Frederick, MD: Wolters-Kluwer; 2013.
  6. Katz NH, Lawyer JW, Sweedler M, Tokar P, and Sosa K. Communication and Conflict Resolution Skills. 3rd ed. Dubuque, IA: Kendall Hunt Publishing; 2020.

Robert Moody, PhD, MS, RVT, is an Assistant Professor of Cardiovascular Sonography at Nova Southeastern University (NSU) in Fort Lauderdale, FL.

Hydrops Fetalis and the Role of Ultrasound in Its Diagnosis and Management

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Hydrops fetalis is severe swelling (edema) in a fetus or a newborn baby, and it is a life-threatening problem. There are two types; immune and nonimmune depending on the cause.

Immune hydrops

The immune version is usually a consequence of Rh incompatibility between the mother and fetus, leading to hemolytic disease of the fetus and newborn (HDFN). If the mother is Rh-negative and is having an Rh-positive baby, the mother’s immune system attacks the unborn baby’s red blood cells. This causes anemia. Hydrops occurs if the developing fetus’s organs are not able to overcome the anemia. Large amounts of fluid will build up in the fetus’s tissues and organs and the heart likely will begin to fail. This type of hydrops is not common today because Rh-negative women are often treated with Rh immunoglobulin to prevent this problem.

Nonimmune hydrops

This is the more common type of hydrops. This type can be caused by many other diseases or complications that may interfere with how a fetus manages fluid. Most of the conditions that can cause nonimmune hydrops are

  • Severe anemia,
  • Infections present before birth,
  • Heart or lung abnormalities,
  • Chromosomal abnormalities and birth defects, and
  • Liver disease and twin-to-twin transfusion.

During pregnancy, symptoms may include large amounts of amniotic fluid, thickened placenta, and ultrasound of the unborn baby may show enlarged liver, spleen, or heart. It may also show fluid buildup around the fetus’s abdominal organs, heart, or lungs.

Post delivery, symptoms include pale coloration, overall severe swelling, especially in the baby’s abdomen, trouble breathing, enlarged liver and spleen.

How to Diagnose Hydrops Fetalis

Ultrasound: This test uses sound waves to create images of blood vessels, tissues, and organs of the fetus. The healthcare provider will use the ultrasound to look at how a fetus’s internal organs are working and can see how blood flows through different vessels.

The first sign of hydrops fetalis on ultrasound is usually the abnormal accumulation of fluid in fetal compartments. This can include skin edema (thickening of the skin), ascites (fluid in the abdomen), pleural effusion (fluid around the lungs), and pericardial effusion (fluid around the heart). These findings are often accompanied by polyhydramnios (excess amniotic fluid) and placental thickening.

Fetal blood sampling: This is done by placing a needle through the mother’s uterus and into one of the fetus’s blood vessels or the umbilical cord.

Amniocentesis: This test is done by removing some of the amniotic fluid around the fetus for testing.

Assessment of Severity: Once hydrops fetalis is identified, ultrasound is used to assess the severity of the condition. Measurements such as the cardiothoracic ratio, the thickness of the skin edema, and the amount of fluid in each compartment help determine the extent of the disease. Doppler ultrasound is also utilized to evaluate fetal blood flow, particularly in cases of suspected anemia or cardiac issues, providing insights into the fetus’s hemodynamic status.

Determining the Underlying Cause: While ultrasound can easily identify the presence of hydrops fetalis, determining the underlying cause requires a more comprehensive approach. For instance, fetal echocardiography, a specialized form of ultrasound, can assess structural heart defects or cardiac dysfunction. In cases of suspected genetic abnormalities, ultrasound findings may prompt further testing, such as amniocentesis or chorionic villus sampling, to analyze the fetal karyotype.

How is hydrops fetalis treated?

Treatment of hydrops depends on the cause. During pregnancy, hydrops may be treatable only in certain cases. The management of hydrops fetalis is complex and depends largely on the underlying cause, gestational age, and the severity of the condition. Ultrasound continues to play a crucial role in monitoring the fetus and guiding therapeutic interventions.

Fetal Monitoring: For ongoing pregnancies, serial ultrasounds are essential to monitor the progression of hydrops fetalis. Regular assessments of fluid levels, fetal growth, and Doppler studies help guide clinical decisions, such as the timing of delivery. In some cases, ultrasound-guided procedures may be performed to relieve fluid accumulation, such as thoracentesis for pleural effusions or paracentesis for ascites.

Intrauterine Interventions: In certain cases, intrauterine interventions may be considered to improve fetal outcomes. For example, in cases of severe fetal anemia, ultrasound-guided intrauterine transfusions can be performed to deliver blood to the fetus. These procedures are highly specialized and require careful planning and execution.

Delivery Planning: The timing and mode of delivery for a fetus with hydrops fetalis are critical and must be carefully planned based on ultrasound findings. In cases of severe hydrops or fetal compromise, early delivery may be necessary to prevent stillbirth or to provide neonatal care. Ultrasound aids in determining fetal lung maturity and guiding the decision on whether antenatal corticosteroids should be administered to enhance fetal lung development. A mother may need to deliver the baby early.

In a newborn baby, treatment may include:

  • Help for breathing problems. This may be with extra oxygen or a breathing machine (ventilator).
  • Removing extra fluid from spaces around the lungs, heart, or inside the belly using a needle.
  • Fetal blood transfusion in cases with immune hydrops.

The Complications of Hydrops Fetalis

The severe swelling that occurs with hydrops can overwhelm the baby’s organ systems. Approximately 50% of live-born babies with hydrops don’t survive and for those that do, there are risks for other problems. Survival often depends on the cause and treatment.

Key Points on Hydrops Fetalis

  • Hydrops fetalis is severe edema in a fetus or newborn baby.
  • It is a life-threatening problem.
  • Hydrops develops when too much fluid leaves the fetus’s blood and goes into the tissues.
  • It is almost always diagnosed during pregnancy or right at birth.
  • Treatment of hydrops depends on the cause.
  • Approximately 50% of live-born babies with hydrops don’t survive.

Conclusion

Hydrops fetalis is a serious and often fatal condition that requires prompt diagnosis and careful management. Ultrasound is an indispensable tool in both the diagnosis and management of hydrops fetalis, offering detailed insights into the severity of the condition, the underlying causes, and the appropriate course of action. By utilizing ultrasound effectively, healthcare providers can improve the prognosis for affected fetuses, offering the best possible outcomes in challenging situations.

Gerald Walter Mosota is a Diagnostic Medical Sonographer in Mombasa, Kenya.

Gerald Walter Mosota

Diagnosing and Mapping Endometriosis With Ultrasound

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About four years ago, I felt like I had made a massive discovery akin to cracking cold fusion or inventing time travel. Although my revelation didn’t win me a Nobel Peace Prize, it forever changed the course of my medical training and gynecology practice. This discovery came through a podcast on Advanced Imaging for Endometriosis. Thus, my journey into the world of advanced gynecologic ultrasound (AGU) and endometriosis began.

The title and details of the mentioned podcast, "Advanced Imaging for Endometriosis" on the Gynecologic Surgeons Unscrubbed podcast dated Tuesday, Mar 23, 2021. The description states, "In this episode, Dr. Cara King speaks with Dr. Mathew Leonardi, an advanced gynecologic surgeon and sonologist (ultrasound specialist) at McMaster University Medical Centre in Hamilton, Canada. As March is Endometriosis awareness month, Mathew talks about advanced endometriosis imagery and how it impacts preoperative counseling, planning, and intraoperative surgical intervention. He also talks about how he created his own path to where he is today. Listen as he shares how to build skills in advance sonography and incorporate this into residency as well as fellowship education."

My years of medical school and residency training had never included this kind of diagnostic capability for endometriosis. The axiom that surgery was how endometriosis was diagnosed was firmly established in my mind. Furthermore, I was astonished that ultrasound, something so ubiquitous in obstetrics and gynecology, was the way to achieve this paradigm shift. I remember sitting in my car listening to Dr. Mathew Leonardi talk about the possibility of not just diagnosing endometriosis before surgery but specifically mapping out where the disease was present. My mind was blown. In my new-found passion for endometriosis diagnosis, I took to the internet.

After a brief exchange on Twitter, Dr. Leonardi graciously agreed to let me shadow his practice for a week. Fortunately for me, Hamilton, Ontario, where Dr. Leonardi worked, was just a short drive and a (sometimes) quick border crossing from where I was completing a residency in Buffalo, New York, so I could witness these transformative ultrasound techniques firsthand. What I experienced that week was a game-changing way to care for patients. Patients with pelvic pain and suspected endometriosis could visit the clinic, undergo a comprehensive pelvic ultrasound, and receive an informed management plan. It wasn’t a model of “let’s see what we find” or broad counseling about options. Patients received immediate information about the scan findings and knew what to expect in the management plan. Furthermore, the therapeutic benefit here cannot be understated. Many patients would tear up feeling validated as their experiences were finally reflected in tangible scan results.

Of course, I was impressed by the patient experience side of AGU. What hooked me even further was the amazing amount of information that one could garner from these ultrasound techniques. Cul-de-sac obliteration, deep endometriosis of the bowel, ureteral strictures, uterosacral ligament lesions, ovarian mobility, and the list goes on. With the wealth of information accessible through ultrasound and my sights set on a surgical practice, I had to learn this transformative skill. A few years later, while in my minimally invasive gynecologic surgery fellowship, I was fortunate to be able to travel to McMaster University and complete a month-long elective with Dr. Leonardi to develop my AGU skills. While this experience greatly advanced my ultrasound capabilities, I believe that anyone interested in AGU does not necessarily need a dedicated month of intensive scanning to bring this skill into practice. The journey starts with a single scan.

Mathew Leonardi and Daniel Nassar smiling and standing in front of the sign for the Department of Obstetrics and Gynecology at McMaster University
Mathew Leonardi, MD, and Daniel T. Nassar, DO, MPH

If you’re interested in starting this journey, enhancing your scanning techniques, or polishing your skills at The Ultrasound Event 2025 conference, I encourage you to sign up for the hands-on training session co-chaired by Dr. Leonardi and me: The UltraSolution Experience: Mastering Next-Gen Endometriosis Ultrasound. In this session, we, along with other experts in AGU, will guide you through simulated endometriosis ultrasounds using the Intelligent Ultrasound ScanTrainer® platform to focus on assessments of findings including bowel and bladder endometriosis. I hope you are as excited to join as we are to share the transformative capabilities of advanced gynecologic ultrasound with you all!

Please feel free to ask any questions about the course or share your journey with gynecologic ultrasound.

I hope to see you at the conference,

Daniel Nassar, DO, MPH
Minimally Invasive Gynecologic Surgery
Dept. of Obstetrics & Gynecology

Optimizing Prenatal Imaging: The Role of Maternal-Fetal Medicine Sonographers

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Ultrasound imaging is a cornerstone of care in high-risk pregnancies, providing essential insights into both maternal and fetal well-being and structural development. But who ensures that these images are not only accurate but also of diagnostic quality, capturing even the smallest details?

A maternal-fetal medicine (MFM) sonographer.

MFM sonographers are the unsung heroes of prenatal imaging, acting as the eyes of Maternal-Fetal Medicine specialists. Imagine being the first to see a tiny heartbeat on the screen of a patient with a history of multiple losses or detecting a complication early enough to save a baby’s life—that’s the kind of impact MFM sonographers have every day. Their expertise goes beyond basic imaging, making their role indispensable in managing high-risk pregnancies.

So, what sets MFM sonographers apart? Their training and skills are specialized and essential to optimizing prenatal care and improving outcomes. Below are some key aspects of their work that demonstrate their unique contributions.

Expertise in Complex Obstetric Cases

MFM sonographers specialize in handling challenging and high-risk pregnancies. These may involve conditions such as congenital anomalies that require detailed anatomical assessment, multiple gestations, where each fetus must be carefully monitored for growth and complications, and maternal health conditions like preeclampsia, diabetes, or autoimmune disorders, which can impact fetal development.

Take, for example, a case where a mother presents for a late anatomy at 32 weeks. The sonographer notices vessels near the lower uterine segment with color Doppler and decides to perform transvaginal imaging to get an optimal view. The transvaginal imaging demonstrates cord vessels crossing the cervix, which is consistent with vasa previa. The sonographer’s detection of vasa previa prompts immediate medical intervention, preventing delivery complications.

With their unique skillset, MFM sonographers can identify and recognize sonographic findings or complications early on. Their ability to provide comprehensive imaging enables Maternal-Fetal Medicine Specialists to make timely, critical decisions affecting both short-term and long-term outcomes for mother and baby.

Specialized Examinations and Advanced Imaging Techniques

In high-risk obstetrics, standard imaging alone may not be sufficient to capture the whole picture. MFM sonographers develop proficiency in various specialized examinations and advanced imaging techniques. Some examples below:

  • Doppler studies to evaluate blood flow in key vessels, such as the umbilical artery, middle cerebral artery, ductus venosus, and maternal vessels, too! (Figure 1.)
Figure 1. Doppler ultrasound.
  • Fetal echocardiography to assesses complex cardiac structures and detect congenital heart defects. (Figure 2.)
Figure 2. Fetal echocardiography.
  • Fetal neurosonography focuses on detailed imaging of the fetal brain and central nervous system. (Figure 3.)
Figure 3A.
Figure 3B.
  • In certain cases, 3D imaging may also be used to aid in diagnoses and management. (Figure 4.)
Figure 4A, Spine.
Figure 4B, Brain.
  • Detailed Anatomy (76811) and Detailed First Trimester Ultrasounds (DFTUs). (Figure 5.)
Figure 5A, Detailed anatomy.
Figure 5B, Detailed first-trimester ultrasound.

Beyond the Image: Critical Thinking in High-Risk Obstetrics

MFM sonographers must possess strong critical thinking skills to adapt to complex obstetric cases’ dynamic and often unpredictable nature. Each scan involves real-time assessment and decision-making. Sonographers must quickly discern between normal and abnormal findings, usually flagging fetal structural anomalies that may require further imaging or immediate intervention. High-risk pregnancies frequently demand deviations from standard imaging protocols, prompting sonographers to use their judgment to determine which additional views or techniques—such as Doppler studies or 3D imaging—are necessary to obtain a complete and accurate assessment. In urgent situations, such as fetal distress or signs of preterm labor, sonographers must prioritize findings and swiftly communicate critical information to the maternal-fetal medicine specialist to facilitate immediate action. These cognitive skills are essential for delivering comprehensive, high-quality imaging that enables timely and accurate diagnoses, ultimately contributing to improved outcomes for mothers and babies.

Becoming an MFM Sonographer: What You Need to Know

Sonographers typically begin their careers by obtaining Registered Diagnostic Medical Sonographer (RDMS) credentials with a specialty certification in Obstetrics & Gynecology (OB/GYN), followed by clinical experience in obstetric imaging. The more experience you gain in performing obstetric and gynecologic imaging, the better prepared you will be. Those who pursue a career in maternal-fetal medicine (MFM) undergo additional training to develop proficiency in high-risk obstetric imaging. Many also pursue advanced certifications, such as fetal echocardiography, to further validate their skills in this specialized field. The role requires a combination of technical proficiency, critical thinking, adaptability, and a commitment to continuous learning to stay current with advancements in ultrasound technology and best practices.

A career in maternal-fetal medicine (MFM) sonography is both rewarding and impactful, offering opportunities to make a real difference in the lives of mothers and babies. Sonographers play a pivotal role in high-risk pregnancies, often being the first to detect critical conditions that can change the course of care. Beyond the emotional rewards, the field also offers career growth opportunities. With advancements in ultrasound technology and an increasing focus on women’s health, MFM sonographers can pursue advanced roles as educators, advanced practice sonographers, or administrative leaders, allowing them to expand their expertise and advance their careers. For many, the opportunity to combine cutting-edge science with compassionate care makes this profession impactful and fulfilling.

Are you interested in learning more about the role of MFM sonographers or how to become one? Join the AIUM’s interactive community discussion hub, “The Ultrasound Forum: Specialized Skills of Perinatology Sonographers,” on March 19, 2025, at 7 pm EST. Hear firsthand from MFM sonographers, physicians, and other experts in the field. Don’t miss this opportunity to ask questions, gain insights, and connect with professionals shaping the future of maternal-fetal care.

Mishella Perez, BS, RDMS, RDCS, FAIUM, is a Clinical Ultrasound Educator at Scripps Health’s Division of Maternal-Fetal Medicine (MFM) in San Diego. She is also Chair of the American Institute of Ultrasound in Medicine’s (AIUM’s) Obstetric Ultrasound Community and is on the AIUM Board of Governors.

Safely Using Diagnostic Ultrasound

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The clinical applications for diagnostic ultrasound have expanded tremendously since its introduction in the late 1950s thanks to technological advancements in both hardware and software, enabling rapid diagnoses at the patient bedside. With this expansion, the medical specialties employing ultrasound as a diagnostic tool have also increased substantially, resulting in a consistently growing group of new users across all levels of medical training and practice.

Ultrasound has long been understood as a low-cost, portable, and ionizing radiation-free imaging method, which has, in part, fueled this rapid expansion. However, ultrasound is ultimately a type of mechanical energy that is able to penetrate tissue, yielding the potential for bioeffects. Practically, the potential for bioeffects is measured through the thermal index (TI) and mechanical index (MI), which provide indicators of the temperature elevation and likelihood of cavitation, respectively, at a particular scan setting. While there have been no independently confirmed adverse effects in humans caused by current diagnostic instruments without contrast agents, biological effects have been reported in pre-clinical mammalian systems, emphasizing the importance of proper clinical use. As diagnostic ultrasound expands to new users and clinical applications, it is imperative that we continue to understand and assess these potential bioeffects and educate new ultrasound users to continue to use ultrasound safely.

The AIUM bioeffects committee has long undertaken this task, examining emerging technologies and making recommendations based on findings. Recently, the bioeffects committee updated its statement on the “Prudent Clinical Use and Safety of Diagnostic Ultrasound”. This statement reaffirms the promise of ultrasound as a safe and effective tool for diagnostic imaging when used properly by qualified health professionals.

Specifically, we emphasize three main ways to ensure diagnostic ultrasound is used safely:

  1. Monitor acoustic outputs—The likelihood of bioeffects can increase by increasing acoustic outputs, indicated by the thermal and mechanical indices. Exposure time should also be monitored, as increased exposure time can also increase the likelihood of bioeffects.
  2. Follow the ALARA principle—The as low as reasonably achievable (ALARA) principle maintains that users employ the lowest acoustic output and shortest scanning time to reasonably achieve diagnostic-quality images.
  3. Only allow qualified professionals to use ultrasound—Ultrasound should be used only by qualified health professionals to provide medical benefit to the patient.

As new diagnostic ultrasound technologies are developed and evaluated, it will continue to be critical to ensure new users understand the proper use of diagnostic ultrasound and the potential for bioeffects, particularly as the use of ultrasound expands beyond traditional use cases and into the future—perhaps even one day into the home!

Alycen Wiacek, PhD, is an engineer, ultrasound researcher, and educator, working to develop new ultrasound-based imaging technologies and improve the quality and diagnostic accuracy of ultrasound. She is a member of the AIUM Bioeffects Committee and is passionate about developing technology to increase access to high quality ultrasound.

A “Hands-Off” Approach to Teaching Ultrasound Image Acquisition

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Traditionally, ultrasound (US) scanning has been considered a hands-on skill requiring in-person training. However, there are numerous situations in which such training is not feasible. The COVID-19 pandemic highlighted the necessity of occasionally limiting exposure to patients, faculty, and staff, prompting a shift toward remote learning. Additional factors, such as patient inability to attend in-person appointments, resource limitations, and an imbalance between the number of learners and clinical opportunities, further underscore the need for innovative teaching methods. In global health settings, geographic barriers sometimes prevent instructors from providing in-person training, making remote solutions indispensable.

Despite these challenges, tele-ultrasound (tele-US) teaching presents unique opportunities to bridge the gap. Yet, one major obstacle remains: teaching image acquisition. As noted in the literature, image acquisition during tele-US instruction is a key difficulty. Challenges include explaining transducer manipulation without instructors’ physical presence, as well as accounting for variables like transducer position, transducer angles, patient positioning, and breathing. These concerns have been documented by Recker et al. in their review of ultrasound in telemedicine (Recker F, Höhne E, Damjanovic D, Schäfer VS. “Ultrasound in Telemedicine: A Brief Overview.” Applied Sciences. 2022; 12(3):958. https://doi.org/10.3390/app12030958).

Interestingly, some studies suggest that tele-US training can achieve comparable outcomes to in-person methods. Research by Soni et al. during the COVID-19 pandemic found no significant difference in post-test knowledge between tele-US and in-person training groups (Soni, Nilam J., et al. “Comparison of In-Person versus Tele-Ultrasound Point-of-Care Ultrasound Training during the COVID-19 Pandemic.” The Ultrasound Journal. 2021; 13;article 39. https://link.springer.com/article/10.1186/s13089-021-00242-6). Faculty expressed frustration with the inability to physically demonstrate transducer control. The barriers cited by faculty were echoed in a study by Schroeder et al., which addressed the challenges of teaching sports ultrasound remotely during the pandemic (Schroeder AN, Hall MM, Kruse RC. “Sports Ultrasound Training During a Pandemic: Developing a “Hands-on” Skill Through Distance Learning.” Am J Phys Med Rehabil. 2020; 99(9):860–862. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363391/). Interestingly though, in Soni’s study, learners often preferred troubleshooting their own images without physical intervention. This finding suggests that “hands-off” instruction might foster autonomy and deeper learning.

Adopting a “hands-off” approach to teaching ultrasound image acquisition is not only possible but can also be highly effective. This method involves avoiding direct contact with the transducer after an initial demonstration, and instead guiding learners through verbal instructions. Many learners find this approach advantageous, as it empowers them to develop their transducer manipulation skills independently. For instructors, the key lies in shifting focus from “What is the probe doing?” to “What is the image doing?”. To teach image acquisition without physical guidance, break the question “What is the image doing?” into manageable components:

  • Is the near field moving?
  • Is the far field moving?
  • Are you moving through a structure (x-axis), or is the structure moving in relation to the leading edge (y-axis)?

Use the following images to further understand these concepts:

By analyzing these aspects, instructors can provide precise feedback and help learners make necessary adjustments. This technique is versatile and can be applied in both in-person and remote settings. It is particularly useful during retrospective image reviews, where instructors can guide learners in interpreting images and refining their transducer manipulation skills.

The “hands-off” teaching method not only adapts to the constraints of remote learning but also encourages learners to develop critical thinking and self-sufficiency. By practicing this approach, instructors can enhance their ability to guide students effectively, even in challenging circumstances. Whether teaching remotely or in person, this method offers a valuable framework for ultrasound education. Try it with your learners today!

Lauren D. Branditz, MD, FACEP, AEMUS FPD, is a Clinical Assistant Professor of Emergency Medicine and Assistant Director of the Emergency Medicine Division of Ultrasound at The Ohio State University. Dr. Branditz is also the Vice Chair of the AIUM’s Ultrasound in Medical Education community of practice.

The graphics included in this blog post were created via modification of images originally published in the following article:

David P. Bahner, et al. Language of transducer manipulation: codifying terms for effective teaching. J Ultrasound Med 2016; 34:183–188. https://doi.org/10.7863/ultra.15.02036.

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

January 2025 Member Spotlight: A Celebration of AIUM Membership

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In this interview, we celebrate the remarkable journey of a longstanding member of the American Institute of Ultrasound in Medicine (AIUM), Abdelaziz Saleh, MD, PhD. With over three decades of dedication, this esteemed member reflects on the invaluable role the AIUM has played in shaping his career and advancing the field of ultrasound in medicine. From his early decision to join during his Maternal-Fetal Medicine (MFM) fellowship to the impact of the AIUM’s resources, courses, and community, his story is one of passion and lifelong learning.

Through this dialogue, we gain insights into the profound influence of the AIUM’s educational offerings, from its esteemed journal to its cutting-edge postgraduate courses. We’ll also explore the broader meaning of AIUM membership, its impact across medical disciplines, and the lasting relationships built within its vibrant community.

In this, we honor Dr. Saleh, recognizing his member journey, celebrating his enthusiasm for ultrasound, and highlighting the excellence the AIUM inspires in professionals across the globe.

Why did you choose to join the AIUM?

I chose to join the AIUM in 1990 while doing an MFM fellowship. At that time, ultrasound became a big part of the MFM practice. In addition, the concept of Fetal medicine has evolved along with the Fetus as a patient. The AIUM offered a lot to learn. It offered the Journal [the Journal of Ultrasound in Medicine (JUM)], annual meeting, and valuable courses. The AIUM always invited top national and international speakers. In fact, I met great physicians and researchers over the years such as Drs. L. Platt, Abuhamad, Romero, and Mari. These courses and the journal’s CME programs helped me get valuable ultrasound-related CMEs.

What is your favorite AIUM benefit?

My favorite benefit is the Journal and the post-graduate courses. The articles are very well written by clinicians who practice ultrasound. The way the articles are structured, they are very useful offering a question, background information, research results, differential diagnosis, and clinical utility of the studies. The post-graduate courses offered valuable learning opportunities to hear the most recent information by innovative scientists. In fact, many courses made me pay attention to new and future developments in my field (MFM and obstetrics).

What does the AIUM mean to you?

The AIUM means excellence in practicing ultrasound in many fields. My field is MFM, however, I like looking at ultrasound utility in other fields such as rheumatology, cardiology, and GI. Even areas such as dermatology have articles of great interest.

Has being a member of the AIUM helped you in your career? If so, how?

Of course, the membership did further my career. Learning at the annual meetings, post graduate courses, fine articles in the Journal, and CME opportunities. The scientific approach of the published articles helped me to put together good ultrasound and consultation reports. In addition, I made great educational presentations to the sonographers and the residents.

Is there anything else you’d like to share?

I have enjoyed being a member of the AIUM for more than 30 years. I appreciate the dedication and hard work of the great team at the AIUM. I am a member of various professional societies, and AIUM membership is the most useful and the most important in the filed of ultrasound in medicine. I am a fan!!!!!!!!!!!

Dr. Abdelaziz Saleh, MD, PhD, is a maternal and fetal medicine obstetrician-gynecologist at Akron General Hospital in Ohio.

6 Ultrasound Trends to Watch in 2025

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The field of ultrasound technology is rapidly evolving, with advances that promise to reshape diagnostic imaging and patient care. As we begin 2025, several exciting trends are emerging, driven by breakthroughs in artificial intelligence, portability, and precision imaging. Here, we explore six ultrasound trends that are set to make waves in the medical field in 2025.

1. AI-Powered Ultrasound Diagnostics

Artificial Intelligence (AI) is transforming ultrasound imaging by automating complex tasks and enhancing diagnostic accuracy. In 2025, we expect AI to play a central role in streamlining workflows.

AI algorithms are increasingly capable of analyzing ultrasound images to detect and measure abnormalities, such as tumors, cysts, or cardiovascular issues, with speed and precision. These systems can assist practitioners in diagnosing conditions at an earlier state, reducing the risk of misdiagnosis. Moreover, real-time AI guidance is being integrated into portable devices, making it easier for clinicians to perform and interpret scans in remote or underserved areas.

For example, machine learning models are being trained to help ultrasound practitioners evaluate fetal development, monitor chronic diseases, and even predict patient outcomes. As these tools become more accessible, AI-driven ultrasound diagnostics will help address global disparities in healthcare delivery.

2. Therapeutic Ultrasound

Beyond diagnostics, ultrasound is increasingly being used for therapeutic purposes. Therapeutic ultrasound employs high-intensity sound waves to treat a variety of medical conditions by delivering targeted energy to tissues.

Applications of therapeutic ultrasound include treating kidney stones, fibroid, and prostate disease, as well as enhancing drug delivery and alleviating chronic pain. Focused ultrasound therapy is also making significant strides in oncology. It’s used to ablate tumors non-invasively using either thermal or mechanical effects and the latter has been found to also promote abscopal immune responses. Additionally, this technology is showing promise in neurology, with research exploring its potential to treat conditions like Parkinson’s disease, addiction, and depression by stimulating specific areas of the brain.

As the technology continues to advance, therapeutic ultrasound offers a noninvasive alternative to traditional surgical procedures, reducing recovery times and minimizing risks. In 2025, look out for this application as it gains more widespread adoption in both clinical and research settings.

3. Miniaturization and Portability

Portability is becoming a common feature of next-generation ultrasound devices. Compact and lightweight handheld units are set to become even more powerful in 2025, enabling point-of-care imaging in ways that were unimaginable just a decade ago.

These miniaturized devices are equipped with wireless capabilities, allowing clinicians to transmit data seamlessly to cloud-based platforms or electronic health records (EHRs). In emergency situations, paramedics and first responders can use portable ultrasound to assess internal injuries on-site, significantly improving patient outcomes.

Additionally, this trend aligns with the growing focus on telemedicine. Patients in remote or rural areas can now benefit from real-time imaging performed by trained technologists and reviewed by specialists miles away.

4. High-Resolution 3D and 4D Imaging

The demand for high-resolution imaging is pushing the boundaries of 3D and 4D ultrasound technology. By 2025, these systems will deliver clearer, more detailed images, providing clinicians with enhanced diagnostic capabilities.

4D ultrasound, which adds the dimension of time to 3D imaging, is especially beneficial in fields like obstetrics, where it offers real-time visualization of fetal movements. Beyond obstetrics, high-resolution imaging is proving invaluable in cardiology and oncology, enabling practitioners to visualize complex structures such as heart valves or tumor margins with greater clarity. This technology also bridges the gap and allows for greater reliability of mutual registration between ultrasound and MRI, CT, and PET.  

Image resolution improvements are accompanied by generally more affordable ultrasound technology overall, making sonography a first radiologic assessment tool accessible to smaller clinics and facilities worldwide.

5. Integration With Wearable Technologies

Wearable devices are stepping into the ultrasound space, promising to revolutionize how and where imaging is conducted. These devices, which can be worn as patches or integrated into clothing, are designed to provide continuous monitoring of specific conditions.

In 2025, you may see wearable ultrasound being used for applications like tracking cardiovascular health or monitoring chronic conditions such as kidney disease. For instance, a wearable device could continuously measure blood flow or detect abnormalities in real time, alerting healthcare providers to intervene in a timely manner.

This trend aligns with the broader movement towards personalized medicine, where patients take a proactive role in their healthcare with the help of smart technologies.

6. Expanded Use of Contrast-Enhanced Ultrasound (CEUS)

Contrast-enhanced ultrasound (CEUS) is gaining traction for its ability to improve visualization of blood flow and tissue vascularity. Unlike traditional ultrasound, CEUS uses microbubble contrast agents that provide detailed imaging without exposing patients to ionizing radiation or iodinated contrast material.

In 2025, CEUS is expected to find broader applications, particularly in oncology and cardiology. It is being used to assess heart function more accurately, differentiate between benign and malignant lesions, monitor the efficacy of cancer treatments, and has therapeutic applications. The latter is a unique demonstration of ultrasound having both diagnostic and therapeutic indications. 

The noninvasive nature of CEUS, combined with its diagnostic precision, is making it a preferred option for patients and providers alike. As regulatory approvals expand and more clinicians are trained to use this technology, CEUS will likely become a standard in advanced diagnostic imaging.

Conclusion

Ultrasound technology is undergoing a renaissance, driven by advances in electronics, miniaturization, portability, and imaging algorithms, including AI. As we move into 2025, these trends are set to enhance diagnostic capabilities, improve patient outcomes, and make imaging more accessible than ever before.

For healthcare providers and institutions, staying ahead of these trends will be critical in delivering cutting-edge care. Whether through adopting AI-powered solutions or CEUS, integrating wearable devices, or exploring new techniques like therapeutic ultrasound, the future of ultrasound is brighter—and more innovative—than ever.

Therese Cooper, BS, RDMS, is a sonographer and the Chief Learning Officer at the American Institute of Ultrasound in Medicine.

Top 5 Posts of the Year: Insights and Innovations

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As the field of sonography continues to evolve, staying informed about the latest trends, challenges, and advancements is crucial for professionals and students alike. This year, we’ve seen remarkable developments in technology, education, and clinical practices that are shaping the future of diagnostic imaging. From groundbreaking innovations in neurosonography to the urgent call for more student training opportunities, these posts reflect the most impactful discussions and insights of the year.

Here are the top five blog posts on the Scan that captured attention and sparked conversations across the community this year.

Ultrasound to Differentiate Benign From Malignant Ovarian Tumors—Are We There Yet?
In this post, Jacques Abramowicz, MD, FACOG, FAIUM, discusses the role of ultrasound in distinguishing benign from malignant ovarian tumors, emphasizing the importance of accurate diagnostic criteria due to the high mortality associated with ovarian cancer. It reviews key ultrasound features, such as size, appearance, and blood flow characteristics, alongside advanced scoring systems like the IOTA Simple Rules, ADNEX model, and O-RADS framework, designed to assist non-experts in diagnosis. The post highlights the effectiveness of these methods in improving diagnostic accuracy while stressing the importance of expert evaluation in inconclusive cases.

Exploring the Future of Ultrasound: 5 Trends to Watch
Therese Cooper, BS, RDMS, highlights in this post five key trends shaping the future of ultrasound technology: portable and handheld devices, artificial intelligence integration, advancements in 3D and 4D imaging, increased use of point-of-care ultrasound (POCUS), and therapeutic applications like noninvasive surgeries and targeted treatments. These innovations promise to make ultrasound more accessible, efficient, and versatile across diverse medical settings, further solidifying its role in modern healthcare. The future holds exciting possibilities for enhanced imaging and expanded diagnostic and therapeutic uses.

Fetal Neurosonography
This post by Eran Bornstein, MD, emphasizes the importance of fetal neurosonography, a specialized ultrasound technique for detailed assessment of fetal brain anatomy, offering superior diagnostic capacity compared to routine screenings. While effective in diagnosing various brain malformations and reassuring patients, its practice in the U.S. is limited due to a lack of training and awareness, and the absence of a dedicated procedural code. The post advocates for increased education, standardized guidelines, and broader access to this critical diagnostic tool.

Introduction to the Emerging Field of Post Cranioplasty Neurosonography
Another post by Eran Bornstein, MD, FACOG, FAIUM, along with Netanel Ben-Shalom MD, FNPS, and David Langer, MD, FNPS, introduces post-cranioplasty neurosonography, a cutting-edge field enabled by sonolucent cranial implants that provide an acoustic window for ultrasound imaging of the adult brain. These implants allow for detailed, real-time brain assessments in various planes, aiding in postoperative monitoring for complications such as hemorrhage, midline shift, and shunt evaluation. As the technology evolves, its integration into patient care holds potential to reduce reliance on radiation-heavy imaging modalities, improve point-of-care diagnostics, and lower healthcare costs, though questions remain about optimal implementation and clinician roles.

Getting Sonography Students Hands-on Experience
In this post from 2022, Kathryn A. Gill, MS, RTR, RDMS, highlights the urgent need for OB/GYN practices to provide hands-on training opportunities for sonography students to ensure a steady pipeline of skilled professionals in the field. Overcrowded schedules and burnout among current sonographers are limiting student rotations, potentially jeopardizing the future workforce. The author calls for creative solutions and collaboration within the sonography community to integrate students into clinical environments, stressing that this effort is critical to maintaining high standards of OB sonography care.

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