I Enjoy Being a Detective

Posted on August 18, 2015 by aium14750

I chose the specialty of radiology, and subsequently diagnostic ultrasound, because I enjoy the “detective” aspect of medicine. It is exciting to use diagnostic imaging to attempt to determine the cause of a patient’s illness. Obstetrical ultrasound has been of interest because most pregnant patients are healthy and happy and one always got an answer, whether right or wrong, 20-30 weeks hence.

I began my career in ultrasound in 1976 joining Dr. Roy Filly at UCSF. He and I are still practicing (perhaps the longest pair in academic medicine). The early days of arguing whether it was better to view images as white on a black background or black on a white background and whether static articulated arm scanning was better than “real-time scanning” are long gone, replaced by incredible technology.

Peter Callen The pitfalls of image analysis has been a curiosity of mine. I have always been intrigued as to how one looks at a series of images and achieves the right (or occasionally wrong) conclusion. I am thrilled that most medical centers are introducing diagnostic ultrasound to medical student teaching early in their training. This has helped generate a lot of awareness and better understanding of our specialty. I am proud to have been a member of our organization, the AIUM. While there are some that only know the AIUM for its guidelines, it has served as a strong core of support for our specialty for the past several decades with support and advice to and from ultrasound professionals, including physicians, sonographers, scientists, engineers, other healthcare providers, and manufacturers of ultrasound equipment. This award is especially meaningful to me to be included with the true founders and leaders of our specialty.

What is your story? Why did you start using ultrasound? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dr Peter Callen received the 2015 Joseph H. Holmes Clinical Pioneer Award from the AIUM. Dr Callen’s contributions span decades and he is currently Emeritus Professor of Radiology, Obstetrics, and Gynecology at the University of California, San Francisco.

Ultrasound Can Catch What NIPT Misses

Posted on August 4, 2015 by aium14750

A few months ago a young couple, Michele and Dan, came to my office for a mid-trimester fetal anatomic survey at 21 weeks’ gestation. They were excited to see their fetus in 3D-4D ultrasound, and were wowed by the 3D image of their baby’s face. During the scan the couple related that they were sure their baby was OK “because the blood test came back negative,” and had decided to forego first trimester screening, despite their OB strongly recommending it.

unnamed The blood tests, nuchal translucency measurement, and other sonographic parameters evaluated in first trimester screening are considered together to provide a risk profile for fetal chromosomal anomaly, particularly the risk of Down syndrome. If there is an increased risk, the parents may be advised to undergo invasive testing, such as chorionic villus sampling (CVS) or amniocentesis. In addition, first trimester screening can raise warning flags for structural anatomic malformations in the fetus, as well as other problems for the pregnancy. If first trimester screening includes a full fetal anatomic survey, it can spot about 40% of fetal malformations at a very early stage.

While I was reassured that Michele and Dan’s results on noninvasive prenatal testing (NIPT) meant the risk of their baby having Down syndrome and certain other aneuploidies was extremely low, I explained that structural malformations were still a much more common concern than chromosomal anomalies, and that a negative NIPT result did not rule out other conditions. Michele protested, “On the Internet it said that the blood test rules out Down syndrome 100%, that we didn’t have to worry.”

“The screening tests only give you a risk profile,” Dan insisted, “they don’t tell you if the baby is really affected. So we thought the blood test was the way to go.”

“I don’t want to have an amnio,” Michele continued, “I had a miscarriage in my last pregnancy,” she continued, as I proceeded to the echocardiography portion of the examination.

“Your baby appears to have a heart defect,” I said, as gently as I could, and began to explain the nature of transposition of the great arteries (TGA).

NIPT is the name applied to new techniques that use a sample of a pregnant woman’s blood to examine her fetus’s chromosomes. As early as 10 weeks of pregnancy there is sufficient fetal genetic material, called cell-free DNA, found in the maternal serum to allow analysis. A negative result from NIPT is a very good test to rule out Down syndrome in the fetus: it is highly specific, meaning that in almost all cases, a negative result is truly negative. NIPT is also highly sensitive, which means that in almost all cases, a positive result is truly positive. However, because there is a chance (however small) of a false positive (a healthy fetus may have a result showing him/her to have Down syndrome), a positive test result always needs to be confirmed with invasive testing, such as CVS or amniocentesis, before any decisions are made regarding the further management of the pregnancy. NIPT has also been found useful in identifying fetuses with other chromosomal anomalies and certain other genetic conditions. NIPT can also be used to determine the fetal sex.

However, while NIPT does a very good job at what it is designed for: looking at fetal chromosomal complement in specific conditions, it does not examine all the fetal chromosomes, nor does it look at the anatomy of the fetus. Fetal anatomy is examined in detail by ultrasound scanning. There is some debate among practitioners regarding the optimal week of pregnancy when full early fetal anatomy scanning should be performed. Some practitioners prefer performing the scan at the time of nuchal translucency screening, 11-13 weeks, while others prefer 14-16 weeks, when the fetal organs are more developed. The important point to remember: a fetus with a normal (negative) NIPT result can have an anatomic structural malformation. It has been shown that while fetuses with malformations may be at increased risk of chromosomal anomaly, the majority have healthy chromosomes. The diagnosis of a malformation by ultrasound should prompt invasive testing such as CVS or amniocentesis. In some centers, more detailed investigation by chromosomal microarray analysis (CMA), which may discover subtle anomalies, will also be ordered. CMA detects duplicated or deleted chromosomal segments and translocations—rearrangements of chromosomal structure, which may not be evident on traditional karyotyping.

NIPT is a very reliable test. But patients may have a false sense of security regarding their baby’s well-being. A negative NIPT result cannot rule out anatomic structural malformations in the fetus, nor does it rule out all chromosomal anomalies. There is ongoing debate surrounding the integration of NIPT into existing screening programs.

I continued to follow Michele and Dan in the weeks and months that followed. They were, of course, shocked and dismayed by their diagnosis. With Michele at 21 weeks, we immediately arranged multidisciplinary consultation with the cardiologists, who explained the procedures the baby would have to undergo, and how Michele’s plans for the birth would have to change. Prenatal diagnosis of TGA can improve the baby’s surgical outcome, and with prompt intervention, prognosis is excellent. They met with a genetic counselor, and despite Michele’s fears, underwent amniocentesis. CMA is performed in all such cases in our center. Testing ruled out genetic syndromes that we suspected based on the anatomic malformation, none of which could have been diagnosed by NIPT.

With comprehensive information in hand about their baby’s prognosis and the options open to them, Michele and Dan decided to continue the pregnancy, despite the difficult road they knew was ahead. They made arrangements for delivery in the tertiary care center where the baby would undergo surgery, so she would not have to be transferred from their community hospital and would be under constant surveillance. “I fell in love when I first saw the baby’s face in 3D,” she told me. “Whatever comes, we’ll handle it together.”

How do you think NIPT should be integrated into prenatal care? How do you advise your patients who ask about NIPT? Have you encountered patients with negative NIPT results whose fetus has a structural anomaly? Have you encountered patients with false negative or false positive NIPT? Comment below or let us know on Twitter: @AIUMultrasound.

Simcha Yagel, MD, is Head of the Division of Obstetrics and Gynecology Hadassah-Hebrew University Medical Centers, Jerusalem, Israel, and Head of the Center for Obstetric and Gynecological Ultrasound at the Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem. He served as moderator for a panel discussion, “Noninvasive Prenatal Testing and Fetal Sonographic Screening,” that appeared in the March 2015 issue of the Journal of Ultrasound in Medicine.

Why I Applied to be an AIUM Fellow

Posted on July 21, 2015 by aium14750

Working in an academic department, we are encouraged to become involved in the ultrasound community as well as keep abreast of the constantly changing field of sonography. After attending my first AIUM Annual Convention early in my career, I quickly realized that the AIUM was an organization in which I wanted to become more involved. The knowledge base was high and many of the members were and still are leaders in research, clinical work and patient care. It was confirmation that I make an impact on patient outcomes every time I pick up a transducer.

TBpix As a reflection of that, I wanted to grow in my AIUM membership. I took the first step in 2005 when I applied for senior membership status, which I was happy and proud to be awarded in the spring of 2006. It took me several years to take the next step, but after meeting the membership requirements, I applied to be an AIUM Fellow. It was a great feeling when I was notified that I had joined the exclusive ranks of AIUM Fellow.

Going through this process was both a professional and personal goal. It was and is an honor to be individually recognized by my peers on both a national and international level.

For those of you interested, the overall application process was straightforward and didn’t take a lot of time to complete. It was pretty clear and straightforward. Plus, the AIUM staff was excellent in keeping me updated on the process and deadlines. There were definitely times when I needed a reminder.

We are all busy with our professional and personal lives; however, I am excited and proud to have taken the steps to illustrate to myself and my peers how much I value my career in ultrasound. I appreciate the AIUM for identifying the substantial effort ultrasound professionals put forth daily for the accurate diagnosis and safety of patients.

What’s your membership story? What accomplishment are you most proud of? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Teresa Bieker, MBA, RT, RDMS, RVT, RDCS, FAIUM, is Lead Diagnostic Medical Sonographer at the University of Colorado Hospital.

Only 260 AIUM members have applied and been granted the distinction of being an AIUM Fellow.

Why My Relative is a Bad Writer

Posted on July 7, 2015 by aium14750

A relative of mine, whose privacy will be maintained, fancies herself a writer. Historical fiction is her self-proclaimed genre. Unfortunately, she is not a good writer and reading her stories is akin to listening to nails scratching a chalkboard. My suggestion to her, without revealing how I truly felt about her writing, was to read as much historical fiction written by others as she possibly could. Her response was, “I don’t like reading other people’s fiction.” You can imagine how hard it was to restrain the thought that ran through my head, “Now you know exactly how I feel about reading yours.”

Heller The point of this anecdote is to help explain why I decided to become a reviewer for the Journal of Ultrasound in Medicine (JUM). You cannot possibly expect to be a good manuscript writer without reading as many manuscripts written by others as you can. And what’s even better than reading an already edited and published “fit-to-print” manuscript is to read one in its gestational state, (sometimes) full of awkward sentences, confusing presentations of data, and tables that are impossible to digest.

When I was first invited to become a reviewer for JUM, I was (presumably jokingly) instructed by top editorial staff members to “ignore the email invitation at your own peril.” Being a first-time manuscript reviewer can be a bit intimidating. You begin to question your own qualifications: “What makes my opinion valuable?” “Who am I to criticize someone else’s writing?” As a regular reader of this or any medical journal, you are exactly the person from whom opinions and criticism count. You are the intended audience of the writing and, as such, the manuscript needs to appeal to you, not only in medical accuracy, but also in relevance and in the style in which the information is presented.

A good manuscript needs to be consistent. It needs to flow effortlessly and consistently from abstract to discussion. The first step I take in reviewing a manuscript is to read it from beginning to end, without making any suggestions. I want to digest the information in the state in which it was originally presented. While this can sometimes lead to indigestion and heartburn, I resist the urge to scribble any comments, questions or suggestions along the margins of the article…at this point.

I wait anywhere from several hours to several days to allow my digestive tract to return to normal (I find probiotics to be particularly helpful for this). Then I reread the article more carefully and more slowly, dissecting each sentence, in particular the data, making sure that information is consistently presented throughout the paper and that the numbers add up. I avoid correcting grammar and linguistic choices (my grandmother, the eternal grammarian, would roll over in her grave), knowing that there are great copy editors who will take care of this. I do ensure, however, that I correct any words that are medically inaccurate (i.e., incorrect abbreviations, suboptimal word choices for ultrasound techniques).

In addition to confirming that the information is presented in the correct section, (i.e., results are not included in the materials and methods section), I ask myself what I would do differently if I were to write the paper. Is the number of subjects adequate? Does the work add substantially to the literature? Is the conclusion appropriate for what was actually done? Might the work alter medical care? Are there any pertinent articles that have not been included in the references section? Do the tables help to more clearly represent the results or are they unnecessary? Is JUM the appropriate journal for this article?

In summary, the more articles you read and, in particular, the more unedited articles you read, the better a manuscript writer you will become. Of this, I am certain. Whether or not you choose to write scientific manuscripts, historical fiction or perhaps screenplays for the next hit HBO series, the more you know about what’s already out there and how it was written, the better your own work will be.

What are your writing, reading, editing tips? Have you ever written for JUM? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Howard Heller, MD, specializes in diagnostic radiology at Brigham and Women’s Hospital, Department of Radiology. He is also on JUM‘s editorial advisory board.

Because Adults Need to Play

Posted on June 23, 2015 by aium14750

One of my favorite TedMed 2014 talks is by Jill Vialet, CEO and Founder of Playworks titled “The Power of Play”. In it Jill describes how people and circumstances are transformed through play. There is actually a physical and mental function which play serves in our daily lives. When I first began educating health care providers in ultrasound internationally, I noticed this. Amidst directing and organizing courses–alternating lectures first, then lectures last; hands-on stations first with flipped classroom pre-class; a half-day course; a two-day course; or even a three-day course. The combination matrix never really mattered and the post-course evaluations never varied.

SonoGames 3 However, one key piece of each course always ensured a winning recipe for sealing the learners’ knowledge and ending on a greatly positive note.

That was the final day’s game of Jeopardy®.

Yes, splitting the adult course attendants in two competing teams and having them play a game. Despite the relatively benign prize of candy, having them play promised a room full of noise, laughter, positive feelings, and raving post-course evaluations.

From India, Ireland, Sri Lanka, and Ghana, it didn’t matter the country. It didn’t even matter if they knew the rules of the game. What mattered, and what made the course, was play. This was true for the learners as well as the educators.

As the president of the Academy of Emergency Ultrasound (AEUS) of the Society for Academic Emergency Medicine (SAEM) in 2011, I was allotted 4 hours of conference time to plan as I wished. I immediately saw this as an opportunity to create and innovate. I envisioned a 4-hour game event of fun, focused ultrasound education, and resident competition. My friend Y. Teresa Liu, M.D. (Harbor-UCLA Medical Center) had told me about running an ultrasound game event with our mutual good friend David Bahner, MD. (the Ohio State University Medical Center). I conferred with my education officer Andrew Liteplo, MD. (Massachusetts General Hospital). He loved the idea.

The SonoGames® was born.

Since that first year, we have increased the aspects and the intensity of play. This past year, the organizing committee dressed in costume commensurate with the conference city. There was a best team costume competition, a best team name award, and the teams competed for medals and for the opportunity to bring the SonoCup to their home institution.

I am convinced that the success of this event is due to its focus on play and fun. We are now planning for the 2016 SonoGames® and I suspect there will be even more play, fun, laughter, and learning. If you want to learn more about the details of how we structured the games, check out the article that appeared in the Journal of Ultrasound in Medicine. And, if you think you are up to the challenge, get your 3-member ultrasound-savvy team ready to compete!

How do you play? What other ideas do you have to incorporate play and ultrasound? Have you ever competed in an ultrasound event? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Resa E. Lewiss (@ultrasoundREL) is the Director of Point-of-Care Ultrasound at the University of Colorado. She has published on medical education and Point-of-Care Ultrasound. Check out her TedMed2014 talk.

Why 76811 Accreditation?

Posted on June 9, 2015 by aium14750

Starting in 2013, the AIUM and the Society for Maternal-Fetal Medicine (SMFM) co-led a task force of medical societies to explore what distinguished a 76811 examination from the more routine 76805 examination. The result of that task force was the “Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination,” which was published in the February 2014 edition of the Journal of Ultrasound in Medicine.

aium_accred The report concludes that the 76811 is a distinct examination that requires special expertise. While many obstetricians and radiologists perform the 76805 on a routine basis, the skills and detail required for a 76811 generally require additional training and expertise—frequently through a Maternal-Fetal Medicine fellowship or similar targeted radiology fellowship.

Unfortunately in practice, what constitutes a “detailed obstetrical ultrasound” (or a 76811 examination) varies tremendously. It was for this reason that the AIUM felt it was critically important to promote standardization of what is required of such an examination and work to ensure that individuals performing these are competent and qualified. Additionally, given the move by some payors to reimburse only examinations performed by accredited practices, the AIUM felt it was prudent to have a mechanism in place to accredit practices that would be qualified to perform these examinations before it was directed by the insurers.

To address these concerns the AIUM developed the 76811 accreditation. This new accreditation is an “adjunctive” accreditation for practices that have, or are seeking, accreditation in 2^nd/3^rd trimester obstetrical ultrasound. It operates very similarly to how 3-D gynecologic ultrasound accreditation is an adjunct to the basic GYN ultrasound accreditation.

If your practice is performing detailed ultrasound examinations for women at high risk of, or who are suspected of having, an anomaly, you should consider adding the 76811 accreditation.

The structure for this accreditation submission is a little different however. Because the consensus statement provided a long list of “always must show” anatomy, and an additional list of “when clinically indicated” anatomy, the accreditation submission must show all of the “always” anatomy on each of the normals, but only needs to show an example of a selection of the “when clinically indicated anatomy” structures on at least one of the studies. In this way, you can exhibit competence getting the views that are occasionally, but not always, needed without having to add a lot of extra views to all of your study submissions.

This newly added accreditation option is live now. The AIUM is excited about letting you demonstrate your expertise so that you can get the credit and recognition that you deserve. Once again, the AIUM is involved in setting the standards for quality, and we know our members are up to the challenge!

Have questions about this new accreditation option? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dr. David C. Jones is Director, Univerisity of Vermont Medical Center Fetal Diagnostic Center and Professor, Obstetrics, Gynecology & Reproductive Sciences at the University of Vermont, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Maternal-Fetal Medicine. He serves as Vice Chair of the AIUM’s Ultrasound Practice Accreditation Council.

The Nerve of Ultrasound

Posted on May 13, 2015 by aium14750

I’m a fan of ultrasound. In the past, ultrasound has been seen as the less attractive cousin of the other imaging modalities, CT and MRI. Maybe that’s why I champion it so much, because I can’t help but root for the underdog! Either way, I am always eager to find ways to incorporate ultrasound in my practice as a musculoskeletal radiologist. It is fast, convenient Ultrasound and MRI of Nerve and inexpensive, and patients tend to find the experience less daunting than being in a metal tube.

Now, I think it is high time that ultrasound take a place on the front lines of nerve imaging. We’ve made several advances in the imaging of nerves under ultrasound; nerves have a characteristic appearance on ultrasound and it is often used for image guidance in nerve blocks. In my practice, we use ultrasound to diagnose and treat nerve pathology. However, a lot of nerve imaging is still primarily done via MRI. This is probably because much of the research in nerve imaging has been done in MRI. Additionally, many clinicians are not aware of the diagnostic capabilities of high resolution ultrasound in nerve imaging. I’m hoping to change that!

Funded by a generous grant from the AIUM’s Endowment for Education and Research, my colleagues and I are hoping to compare the utility of ultrasound in nerve imaging to MRI. What we hope to confirm is that ultrasound has similar diagnostic capabilities to MRI in the imaging of neuropathy. In addition, we plan to use ultrasound’s capability for dynamic imaging to produce new methods for evaluation of the brachial plexus and peripheral nerves. This grant will fund one of the largest volume studies of ultrasound in nerve imaging, which will in turn help to further expand the role of one of the most valuable imaging modalities we have. So, hopefully soon, this “underdog” will have its day.

In what other areas is ultrasound emerging from its “underdog” label? Where can we use Ultrasound First? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Ogonna Kenechi “Kenny” Nwawka, MD is the assistant attending radiologist in the Hospital for Special Surgery as well as assistant professor of radiology at the Weill Medical College of Cornell University.

Dr. Nwawka’s research project is being funded by a $50,000 grant from the Endowment for Education and Research. To help support these and other projects, consider donating.

The Issue with Keepsake Ultrasounds

Posted on April 30, 2015 by aium14750

Every cou smiling 3rd tri ple of weeks, the AIUM office receives a call from a reporter asking about keepsake (or entertainment) ultrasounds. Most of these calls result from a keepsake ultrasound facility opening in the community. A number of them came when the FDA reaffirmed its warning against the practice. Occasionally we get the oddball like the one about the ultrasound booth at a flea market.

Regardless of why the AIUM receives the call or inquiry, our response is the same. Since 1999, the AIUM has had the following official position:

“The AIUM advocates the responsible use of diagnostic ultrasound and strongly discourages the non-medical use of ultrasound for entertainment purposes. The use of ultrasound without a medical indication to view the fetus, obtain images of the fetus, or determine the fetal gender is inappropriate and contrary to responsible medical practice. Ultrasound should be used by qualified health professionals to provide medical benefit to the patient.”

AIUM, and a number of other professional associations in the U.S. and other countries, discourage the entertainment use of ultrasound for several reasons, including:

The lack of training of the individuals obtaining the images. When it comes to keepsake ultrasound facilities, there are no regulations governing training requirements for those obtaining the images, either through certification or accreditation.
The concern about potential biological effects that could result from scanning for a prolonged period, inappropriate use of color or pulsed Doppler ultrasound without a medical indication, or excessive thermal or mechanical index settings. As stated in the FDA’s position, “ultrasound can heat tissues slightly, and in some cases, it can also produce very small bubbles (cavitation) in some tissues.”
The potential that pregnant women will visit a keepsake ultrasound facility in lieu of routine prenatal appointments with their medical doctor.

Despite government and medical association warnings against the use of keepsake ultrasounds, the number of facilities performing these scans appears to be increasing. Many theorize that this increase has been driven by the use of 3D ultrasound technology which provides detailed, in-depth images of the fetus and its appeal to expecting parents.

As the number of facilities increases, some states have taken action to ban the practice of keepsake ultrasounds based on the reasons outlined above. In 2009 Connecticut became the first state to ban keepsake ultrasounds. It took 5 years for the second state to take a similar action. Oregon’s law took effect in January of 2014.

Although the issue of keepsake ultrasounds has been around for decades, the recent proliferation of facilities offering this service has prompted action by medical organizations, the federal government, and state governments. Only time will determine the ultimate fate of keepsake ultrasound practices. Until then, the AIUM will continue to advocate for the responsible use of medical ultrasound.

What’s your take on keepsake/entertainment ultrasounds? Comment below or let us know on Twitter: @AIUM_Ultrasound.

The Highs and Lows From AIUM’s Annual Convention

Posted on April 15, 2015 by aium14750

It’s been a couple of weeks since we officially closed the 2015 AIUM Annual Convention hosting WFUMB. More than 1,300 people from 51 countries arrived in Orlando to hear from the experts, network with peers, and learn the latest technology.

And by the feedback we received, it looks like this year’s event delivered. That is not to say that there weren’t some issues—but overall the 2015 AIUM Annual Convention was a huge success. Just a few numbers from the post-Convention survey:

94% of attendees said the overall Convention was good or excellent, which was the same as last year.
70% of attendees said they would make at least some modification to what they are currently doing based on what they learned at the Convention.
91% of attendees said they would recommend the AIUM Convention to a colleague.
90% of attendees said the AIUM Convention was either on par or better than other ultrasound courses/events they have attended.
91% of attendees said they spent time on the exhibit hall floor, with 95% rating the exhibit hall as either good or excellent.

Here’s what you liked
There were three main areas that consistently ranked high: the overall content of the Convention, the multidisciplinary nature of the event, and the food. Here are just a few quotes we received in response to the question, “What did you like most about this year’s Convention?”

“This was my first time with you. I loved everything.”
“Great variability in speakers’ backgrounds. Most conventions I go to are only one specific area of medicine, whereas AIUM had people from many different specialties.”
“Ability to collaborate at lunch–sitting at tables to discuss the conference presentations.”
“Wide variety of course selections. Excellent lectures and slides. Faculty put in much time and as a participant, I could tell.”
“Top-notch faculty and very practical clinically oriented lectures.”
“Welcoming atmosphere for a first-time presenter.”
“The mix of MDs, PhDs, and reps from manufacturers and government. Lunch format was also excellent to maximize opportunities for networking and interactions with colleagues.”

Not all wine and roses

Room temperature. No, those weren’t hot flashes or cold spells. The hotel had a very difficult time adjusting and maintaining the temperature of the meeting rooms. To some extent this happens in every large venue, but the AIUM has already had discussions with the facility about this issue.
Hotel issues. In fact, the AIUM collected all the comments we received about the hotel and sent them to our hotel representative. Don’t worry, we didn’t share your names, just your comments. These ranged from noise levels to the quality of the sleeping rooms to the Green Choice program. Just to clarify, the Green Choice program was not mandated by the AIUM but rather a guest choice on whether or not to participate. We were as unhappy as you were about how this program was delivered and have shared our displeasure with the hotel.
Overflow hotel. As many attendees know, the AIUM sold out of its rooms at the Dolphin resort and we added rooms at Disney’s Animal Kingdom. We heard mixed reviews about this property and related transportation issues. We are actively addressing this now and hope to avoid a similar situation in 2017.
Coffee. We heard it loud and clear that AIUM members need coffee! While there was coffee service in each room, we understand that most days require more than one cup! To that end we are taking a look at the schedule for next year to see what we can do.
Handouts. We heard several comments about the lack of handouts or syllabi. The AIUM is looking into how we can do this for next year while ensuring that attendees have access to the most up-to-date presentations.
Scheduling conflicts. The good thing about the high quality of the content at the AIUM Convention is that attendees want to go to more sessions than is humanly possible. The AIUM and the Annual Convention Committee make every effort to avoid overlap and duplication, but sometimes you do have to make a choice. Our goal is make sure that the choice you make results in learning!

The great thing about the Annual Convention is that we all learn. Attendees learn tips, techniques and resources that help them succeed and the AIUM learns how it can make this event even better. While the 2015 Annual Convention is over, we are already hard at work on the 2016 Annual Convention that will be held April 2-6 in Las Vegas.

Did you attend this year’s event? If so, share your thoughts and feedback. Going next year? Let us know what you want to learn! Comment below or let us know on Twitter: @AIUM_Ultrasound.

Peter Magnuson is AIUM’s Director of Communications and Member Services.

An Idea Whose Time Has Come

Posted on April 9, 2015 by aium14750

By all accounts, French writer Victor Hugo wasn’t talking about ultrasound in medical education when he wrote these words. But fast forward a little more than two centuries and they seem more than fitting.

Med_Ed_Forum_Logo-blue Recent years have seen a reformation of medical school education, something many have argued is long overdue given the changes in medicine and medical practice in the last two decades. Multiple medical schools are actively changing their curricula and many are incorporating novel educational strategies to teach medical students more efficiently and to focus on less esoteric topics. In perhaps a perfect storm during this same period the accuracy of the physical examination is being questioned more than ever while over reliance on imaging and increased radiation exposure are being linked to increased costs and future mortality. Ultrasound has long been proposed by advocates as a critical tool to help address these concerns but in medical education especially, it may be an ideal tool for future physicians.

Ultrasound as taught in a point-of-care setting, or performed at the bedside, can be incorporated into almost every clinical specialty. Its uses range from procedure guidance to focused diagnostic applications allowing accurate bedside diagnosis of multiple disease states. In addition, it is proving to be an excellent adjunct in teaching basic science topics such as anatomy and physiology. Recent literature, representing just the proverbial tip of the iceberg, suggests that ultrasound is superior to the physical examination even if that exam is done by an expert. Additionally, ultrasound helps novices, known as medical students, better learn the basics needed for all medical professions. Given all of this information it is imperative to have a national conversation regarding ultrasound integration into medical school education.

It is with this backdrop that last year, the AIUM and the Society of Ultrasound in Medical Education (SUSME) convened a conference to discuss the state of ultrasound in medical education and to ultimately craft a roadmap for its integration. Forty-two medical schools, 64 attendees, and 13 faculty gathered in New York City to begin this work.

At the outset, it was clear that the level of integration varied among medical schools, with some being fully integrated, some just starting, and others still exploring. But this fact led credence to the need for this event which started with a series of discussions and presentations covering a variety of topics. Ultrasound education leaders discussed how to get started, how to overcome pitfalls and barriers, and where to find support and funding. Many corresponding resources can be found on the AIUM’s MedEd Portal.

Participants then had a hands-on scanning experience with simulation and live models that was designed to show how and where they could integrate medical ultrasound education. This was followed by roundtable discussions during which participants could share their experiences, ask questions, and focus on next steps.

One of the highlights of the event was the students’ perspective. A number of students shared how medical ultrasound education helped them develop confidence and a skill that could be used for them to teach attendings, other students and practitioners across the world. Their enthusiasm and energy definitely created a positive and exciting atmosphere.

The participants came away with a shared understanding that it makes sense to prepare the next generation of clinicians and physicians with the skills and understanding of how and when to use medical ultrasound. However, challenges remain.

Multiple barriers exist and many Deans, associate Deans and other tasked with curricula development are not familiar with current point of care ultrasound use. Additional barriers such as when, where and how to integrate ultrasound into a 4-year curriculum may appear to be unsurmountable, yet have been solved in multiple medical schools already. The collection and efficient distribution of this knowledge is seen as critical to the further spread of ultrasound in medical education and the unprecedented bringing together of multiple basic science and clinical educators.

This event was the first step in opening up the discussion and sharing common resources, challenges and solutions. The second Ultrasound in Medical Education Forum is scheduled to take place May 31-June 1 at the University of California, Irvine. The event is by invitation, but if you know someone who might be interested, please forward their contact information to Glynis Harvey at gharvey@aium.org.

If you are associated with a medical school, how have you integrated ultrasound? If you are a student, what do you think about teaching ultrasound in your classes? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Steven R. Goldstein, MD, is AIUM’s Immediate Past President.

* The 2014 event was underwritten by industry partners and a grant from the Endowment for Education and Research.

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