A Future Career Path for the MSK Sonographer

Posted on February 28, 2017 by aium1952

The sonographic community has the opportunity to take advantage of recent orthopedic surgeons’ interest in diagnostic ultrasound. Although much of the interest was prompted by the usefulness of guided injections, sonographers need to fully appreciate and understand the value of the information derived from an ultrasound study, which will ultimately lead the surgeon to better surgical decisions and better patient outcomes. Once you are a part of the orthopedic diagnostic team, you will be able to function as a specialist Physician Assistant member, adding a new dimension to the orthopedic practice and demonstrating the incredible value of diagnostic soft tissue imaging.

I am a Board-Certified Orthopedic Surgeon, with subspecialty in shoulder orthopedics including arthroscopy and open surgery. I incorporated diagnostic shoulder/MSK ultrasound as part of my office practice 20 years ago especially for evaluation of patients presenting with protracted shoulder pain (in addition to the traditional history and physical exam, and occasional MRI).

I have valued diagnostic shoulder imaging in my practice and determined that all Orthopedic Surgeons should be using ultrasound imaging as part of their usual diagnostic evaluation of patients (especially patients presenting with protracted painful shoulder problems affecting function). In addition, an ultrasound exam with normal findings may be more important than an ultrasound exam that finds some pathology.

I have concluded that the real-time ultrasound examination with comparison to the contralateral side available to the orthopedic surgeon, in most cases, is more valuable than the information obtained from the MRI (especially regarding soft tissue pathology, present or absent).

For example, compare the MRI detail of the supraspinatus with the ultrasound motion clip of the supraspinatus moving under the acromion (see the still MR image below and, at bottom of the page, the 1st video, which is the active ultrasound clip of the supraspinatus). MRI is accomplished with arms immobilized at one’s side, and does not benefit from the study being compared to the contralateral side. However, it produces a nice clear image. The ultrasound image in long axis can be a still image or a motion clip viewing the supraspinatus or infraspinatus moving under the acromion and the reaction causing impingement syndrome, spurs along the anterior lateral border of the acromion, dynamic sub acromial bursitis, or a rotator cuff tear, which may be attritional and similarly present on viewing the asymptomatic shoulder.

figure-1

The Math

The following statistics help to identify the future vital need for the sonographer to become part of the team working with the surgeon in an orthopedic office practice (Orthopaedic Surgeon Quick Facts, www.aaos.org; 10 Interesting Statistics and Facts About Orthopedic Practice, www.beckersspine.com; Am J Orthop 2016;45(2):66-67; 20 Things to Know About Orthopedics, www.beckershospitalreview.com).

There are approximately 28,000 (2012) orthopedic surgeons in the US, 75% of whom are in private practice, and many are in group practices of 2 or more. The general orthopedic surgeon sees an average of 70-90 patients per week, of which an estimated 12% or more have shoulder problems. This equates to 10 orthopedic shoulder evaluations per week for 1 solo general orthopedic practice, and 20 for a 2-man group (in the same office). Ten to 20 patients (minimum) per week would then benefit from ultrasound imaging information, assisting the surgeon in making a surgical decision.

The following image identifies how important the cross axis image is, as well as describes the degree of rotator cuff injury and approximates the relative number of rotator cuff muscle tendon units that have been rendered dysfunctional.

Left, Close to the infraspinatus/supraspinatus interval and insertion site, many fibers are in harm’s way for tendon/fibril tearing. Center, The area for careful X-axis grid examination, looking for possible partial undersurface tearing, fibers losing their connection/attachment to the footplate. Right, Example of an X-axis grid examination of this full-thickness tendon tear, which should be accompanied by an x-axis measurement of the width/base of the triangular tear. Real time examination can help to identify the quality of the tissue, which may require repair. Usually, orthopedic surgeons pay more attention to the MRI reading and the coronal views (ultrasound long axis view). (See the 2nd video clip below for real-time imaging of the X-axis rotator cuff tear.) The X-axis view/measurement is the more important image. The wider the tear, the more tendon fibrils are affected and the more dysfunction to the rotator cuff area involved.

This need for diagnostic shoulder ultrasound information could be sufficient and important enough to support an entire career for an MSK sonographer. All the other valuable areas of MSK expertise that come with the MSK sonographer would be an extra bonus to the orthopedic office practice: helping with other ultrasound examinations, diagnosis, and surgical decisions.

Video clip 3 below is an MSK ultrasound examination for CTS identifying median nerve mobility or restriction within the tissue, questioning the presence of scar tissue restricting motion.

How have you used ultrasound in orthopedic surgery? What other areas of ultrasound are on the brink of emerging in a new field? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Alan Solomon, MD, is a Board Certified Orthopedic Surgeon and Honorary Staff at the Metro West Medical Center, Natick/Framingham, MA.

Ultrasound in Medical Education: How Far We’ve Come

Posted on February 14, 2017 by aium1952

Point of care ultrasound was an obscure elective during my medical school years, a poorly-attended vacation elective to fill the free time between the match and the first day of residency. At the time, the 2 Emergency Medicine attendings directing the course volunteered an expertise, which endured widespread disregard; their craft persisted, unappreciated by the department and hospital. These faculty had a unique passion, a vision of a paradigm shift in medicine that would save more lives, make better decisions, and improve overall care.

I was initially skeptical of that vision. When they expressed excitement over our new, $50,000 Micromaxx (considered a bargain at the time), it sounded to me like the typical exorbitant medical expense with marginal benefit, peddled by savvy sales r morrow_image1 eps. Then we caught our first tamponade in cardiac arrest during a pulse check and I was hooked: POCUS didn’t belong as one of those obscure hobbies limited to the especially nerdy, but was a vital diagnostic and procedural tool, to be learned and disseminated. I went through residency clearly enamored with the technology. To my dismay, early in my internship, we lost our ultrasound director. It was then that I found mentors in podcasts and through the Free and Open Access Medical Education (FOAMed) community.

By my final year of residency, nurses and attendings were calling on me to pause my work in my assigned pod to travel to theirs to help with US-guided procedures. Having identified the need, I started teaching residents and nurses US-guided procedures. The barriers to education were high-quality simulation phantoms, machine access, and educational time. Time we could volunteer, and for machines we begged and borrowed, but for phantoms, we hit a wall. I searched for answers in the young community of FOAMed but found few workable alternatives to the hundred-to-thousand-dollar commercial phantoms. It was at this impasse that I found inspiration from Mythbusters’ use of ballistics gel. I experimented with ballistics gel to create my own phantom and found it morrow_dsf8521 to be an effective and practical alternative to the commercial phantoms. I was approached by several companies aiming to turn this into a money-making opportunity, but I felt this information needed to be shared. This skill was too critical to keep it locked up behind a patent. Instead, with the whole-hearted spirit of FOAMed, I published guides and answered questions and gave cooking classes.

I’ve continued to follow the vision of bringing bedside ultrasound to widespread use, from residency to fellowship, and now into my role as Emergency Ultrasound Director and Director of Ultrasound Education at the University of South Carolina School of Medicine Greenville. The future is bright: the FOAMed community is large and growing; US technology is being integrated into earlier stages of medical education; and pocket machines are bringing US in closer reach of the busy clinician. Ultrasound is moving into the hands of clinicians at the bedside and becoming an extension of our physical exam, and there is a growing literature base to support this trend. Someday ultrasound will take its rightful place next to the stethoscope, and my job as an “ultrasound director” will seem as foreign a concept as “director of auscultation.” The complementary forces of FOAMed and formal medical education will bring us to this future of safer procedures and greater diagnostic accuracy, and I am excited to be a part of it.

How have you seen ultrasound medical education change? What are your favorite FOAMed resources? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dustin Stephen Morrow, MD, RDMS, is Ultrasound Director at Greenville Health System Emergency Medicine, as well as Director of Ultrasound Education at University of South Carolina School of Medicine Greenville. He can be found on Twitter: @pocusmaverick.

Sonographer Stretches for an ‘A’ Game

Posted on January 31, 2017 by aium1952

For our first blog we introduced the reality that there is an epidemic amount of sonographer pain and injury. Almost 90% of sonographers work and live daily with that pain and injury as a result of doing our jobs. That is an epidemic and sinful statistic. As fellow sonographers, we should be incensed that more is not being done to quell the enormous pain and injury that we suffer from.

Coach Rozy and I have the solution. In our first blog with the AIUM, we detailed and gave examples of lower body stretches and exercises that sonographers should do. The folks at the AIUM relayed that our post was very popular among sonographers. Some of the feedback that we received was that many that read our blog thought it was silly that we would suggest doing lower body work for sonographers that predominately suffer from upper body issues (neck, back, shoulders, etc…).

In our 2^nd blog we explained why lower body stretches and exercises are also crucial to good sonographer health and pain-free imaging. My favorite story that Coach Rozy tells is about his time in the National Football League. A prominent quarterback in the league at the time was having pain in his shoulders, and main throwing arm. He couldn’t follow through properly on his pass mechanics due to the pain in his throwing shoulder. Not good, if you are a quarterback in the NFL and you can’t pass properly.

Rozy immediately zoned in and started working the shoulder, with little positive result. A few days later Rozy noticed that this quarterback was walking into the locker room with a limp. He hit him up and was told that he had taken a hard hit on his hip and that it had caused him hip pain. Immediately Rozy started working on the quarterback’s hip. A few days later, the hip was better. At this time the shoulder pain also stopped, and life was good. The problem wasn’t the shoulder. The problem was the hip. The hip injury translated into the shoulder. Fix the hip, fix the shoulder. That’s why when you look at sonographer pain and injury, you must look at the body as a whole, not just the area of pain and injury.

For our 3^rd blog, we want to share why it is absolutely crucial that your work as a sonographer must be done at the very highest level on each and every patient that you work on. An article entitled, “Making a Difference as a Sonographer, 100% Every Person, Every Time” details my own personal battle with my wife’s diagnosis of breast cancer. As you will read, a breast ultrasound is the only test that caught my wife’s cancer. The cancer was caught early, which made her course miraculous, given such a diagnosis. Amazing things happened in Yankton, SD, the day that my wife had her ultrasound study that caught ‘something’. Enough ‘something’ that a biopsy was done, the cancer was found early, and the course for my wife was incredible. As sonographers it is CRUCIAL that we be on our ‘A’ game for every person that we work on.

The following are a few simple, quick, easy stretches that can be easily done at work or home. Working the body as a whole is important.

Lying thoracic spine rotation

Start by lying on the ground on your side (either side). With your arms extended straight out at chest level pull your knees pulled up to your chest. The hips and knees should both be at 90 degrees. Work to have your ankles at 90°. You can use a mat, and for added comfort and support use a pillow.

To begin, keep the knees together (place a rolled-up towel or small ball between the knees if you need more support), move your top arm over your body and toward the floor on the opposite side. The objective is to get the arm and s
houlder blade touching the ground, not just the hand.

All images courtesy of Doug Wuebben.

The goal is to do 2 sets of 8 reps on each side. Tip: You want the movement to come through the thoracic spine — not just the shoulder area.

Kneeling thoracic spine rotation

After completing the lying thoracic spine rotation, progress to the kneeling thoracic spine rotation exercise. This is a more progressive move and requires enhanced control over your posture, movement, and stability.

Begin in a 6-point (some say 4-point) position, on your hands and knees. Take one hand and put it on the base of the skull behind your head. It’s important to keep weight evenly distributed between the legs and your other arm. Keep the bent arm locked in position. The elbow stays pointed toward the ground. Rotate your torso with motion going through the spine, ending so that the bent elbow is pointed up. The movement should come through the back/spine — and not just the shoulder! Take the movement through as large a range of motion as possible. The benefit comes from movement from the thoracic spine. Don’t use your shoulders or hips.

Do 2 sets of 8 reps on each side.

Psoas lunge

Most people consider proper lunge technique to include pushing the hips forward to stretch what they feel are the hip flexors and the psoas. The iliacus crossing the hip is what is stretched in the traditional lunge, but the psoas also crosses the hip and all lumbar joints.

The best way to stretch the psoas occurs when it is isolated with a lunge that includes lateral bending of the spine and twisting and extension motions. This is a great warm-up stretch before running or doing a lower body routine. Stretch and hold for 20 to 30 seconds. Repeat several times, both directions.

Farmer’s walk

Another simple yet effective routine is what we call the farmer’s walk exercise. Pick one or two dumbbells and hold them by your sides. Then walk around your training area. Start by walking 25 yards or you can also time yourself, say for 30 seconds, to begin with.

If you are a beginner, perform the farmer’s walk by carrying any object that has some weight to it. Increase the weight as you progress. The farmer’s walk is a simple yet effective leg-strengthening exercise that works your calves, quadriceps, and hamstrings. The core muscles that help support your spine also benefit. It also creates intra-abdominal pressure to prevent your spine from collapsing.

To vary this routine, hold the weights overhead, use only one weight, or hold one weight overhead and one at your side.

What stretches do you do? How do you improve your posture? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Doug Wuebben BA, AS, RDCS (Adult and Peds), FASE, is a registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers. He has also been published on the topics of telemedicine and achieving lab accreditation.

Mark Roozen, M.Ed, CSCS,*D, NSCA-CPT, FNSCA, is a certified strength and conditioning specialist, a certified personal trainer, and a fellow of the National Strength and Conditioning Association (NSCA).

Wuebben and Roozen are co-founders of Live Pain Free — The Right Moves. They can be contacted at livepainfree4u@gmail.com.

Why SonoStuff.com?

Posted on January 17, 2017 by aium1952

Three reasons:

As a co-director of technology enabled active learning (TEAL) at the UC Davis school of medicine I incorporate important technologies into the medical curriculum, which has primarily been point of care ultrasound (POCUS). Ultrasound is an incredible medical education tool and curriculum integration tool. It can be used to teach, reinforce, and expand lessons in anatomy, physiology, pathology, physical exam, and the list goes on.

I knew there was a better way to teach medical students tha schick_photo_1 n standing in front of the classroom and giving a lecture. Student’s need to learn hands-on, spatial reasoning, and critical thinking skills to become excellent physicians. Teaching clinically relevant topics with ultrasound in small groups with individualized instruction
is the best strategy. I needed to flip the classroom.

I started by creating online lectures for an introduction to ultrasound lecture, thoracic anatomy, and abdominal anatomy:

Introduction to Ultrasound, POCUS

FAST Focused Assessment of Sonography in Trauma Part 1

FAST Focused Assessment of Sonography in Trauma Part 2

Aorta Exam AAA POCUS

Introduction in Cardiac Ultrasound POCUS

Topics quickly grew in scope and depth. I initially housed my lectures on YouTube and emailed them out to students before the ultrasound laboratory sessions. However, I wanted a platform that allowed for improved organization and showcasing. I needed a single o schick_photo_2 nline resource they could go to to find those materials I was making specific to their medical curriculum.

https://www.youtube.com/channel/UCOhSjAZJnKpo8pP7ypvKDsw

Around the same time, during a weekly ultrasound quality assurance session in my emergency department, I realized we were reviewing hundreds of scans each month and the reviewers were the only ones benefiting educationally from the process. Many cases were unique and important for education and patient care.

We began providing more feedback to our emergency sonographers and I decided I could use the same software I was using to develop material for the school of schick_photo_3 medicine to highlight the most significant contributions to POCUS in our department every week. I quickly realized I needed a resource to house all these videos, one that anyone in my department could refer to when needed. The most efficient and creative method was to start a blog. I was discussing the project and possible names for the blog with colleagues and Dr. Sarah Medeiros said, “sounds like it’s a bunch of ultrasound stuff”. https://sonostuff.com was born.

I owe a great deal to free and open access to medical education or FOAMed. I was hungry for more POCUS education in residency and the ultrasoundpodcast.com came to the rescue. I became a local expert as a resident and even traveled to Tanzania to teach POCUS.

schick_photo_4 I primarily began www.SonoStuff.com to organize and share with my department of emergency medicine and school of medicine, but it grew into a contribution to the growing body of amazing education resources that is FOAMed. I now use it as a resource in my global development work along with the many other FOAMed resources.

The work we all do in FOAMed, including AIUM’s the Scan, is an incredible and necessary resource. I have read the textbooks and attended the lectures, but I would not be where I am without FOAMed. I know all or most of those contributing to FOAMed do it out of love for education and patient care, without reimbursement or time off. Thank you to the many high-quality contributors and I am proud to play a small part in the FOAMed movement. schick_photo_5

Michael Schick, DO, MA, is Assistant Professor of Emergency Medicine at UC Davis Medical Center and Co-Director of Technology Enabled Active Learning, UC Davis School of Medicine. He is creator of www.sonostuff.com and can be reached on Twitter: ultrasoundstuff.

Interdisciplinary Education and Training in MSK Ultrasound

Posted on January 3, 2017 by aium1952

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

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

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

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

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

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

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

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

The Spirit of Collaboration – A Tribute to Carmine M. Valente, PhD, CAE

Posted on December 20, 2016 by aium1952

Are you aware of the depth and breadth of engagement activities at the AIUM? Most likely, our flagship enterprises, such as the JUM and the convention, as well as the 18 (and growing!) communities immediately come to mind. And for almost 20 years, AIUM CEO Carmine M. Valente, PhD, CAE, has been at the heart of it all. As we close out 2016, we say goodbye to a leader, a catalyst, and a friend. While Carmine has set his focus on new adventures in retirement, it’s interesting to note how much the AIUM has grown during his tenure.

Back in 1997, the AIUM had 8 communities, known in those days as sections. There were 2 types of practice accreditation – OB/GYN and abdominal/ge carm neral. There are now 12. The EER, in its infancy, had $47,000 in its coffers. Over time, 8 practice guidelines have grown to 31 practice parameters; training guidelines have expanded from 1 to 12; and the number of societies that have worked with us to develop these tools has expanded exponentially.

This growth is a result of a theme Carmine has instilled throughout his tenure—collaboration. Carmine is often heard declaring “It makes no sense for the AIUM to develop [fill in the blank] without looking outward. The more stakeholders at the table, the stronger the result.” The imaging community recognized this as early as 2007, when RT Image recognized Carmine as one of radiology’s 25 most influential movers and shakers. “Dr. Valente has been a key element in facilitating and coordinating these and other important activities that continue to grow both the AIUM and interest in the ultrasound arena.”

Over time, Carmine has partnered with 10 of AIUM’s 31 presidents, enabling them to achieve their goals and further the AIUM mission. In the last 12 years, the AIUM has hosted 9 forums on a variety of topics with dozens of participant organizations at each; and all within the framework of collaboration: Compact Ultrasound (2004); Training/Exam Guidelines and Scope of Practice (2006/2008); Patient Safety and Quality: The Role of Ultrasound (2007); Point-of-Care Use of Ultrasound (2010); Ultrasound First & Beyond Ultrasound First: Quality Imaging (2012 & 2016); and Ultrasound in Medical Education (2014 & 2015).

In October 2016, the AIUM’s Board of Governors established the Carmine M. Valente, PhD, CAE Distinguished Service Award to memorialize and recognize significant contributions to the AIUM and the ultrasound community as a whole by furthering the multidisciplinary nature and collaborative efforts of the organization. Its first presentation will occur at the 2017 AIUM Annual Convention in Orlando, Florida.

For those who visit the AIUM Headquarters, you will see that the AIUM’s primary conference area has been dedicated as an enduring reminder of Carmine’s Spirit of Collaboration. This space will serve as a center for informing, educating, inspiring, and entertaining, and instill a growing sense of belief and pride in our ability to advance the safe and effective use of ultrasound in medicine.

Today, it is endemic of the AIUM’s culture to ask “Who else should be at the table?” whenever a project is discussed. And for that, we thank you, Carmine.

The spirit of collaboration is, in Carmine’s immortalized words, “to be continued…”

Do you have a memory, thought, or story to share about Carmine? Comment below and on Twitter: @AIUM_Ultrasound.

Glynis V. Harvey, CAE, is the AIUM’s Chief Executive Officer Designate & Deputy Chief Executive Officer.

Obsessed With Ultrasound

Posted on November 8, 2016 by aium14750

1. Tell us how and why you became interested in ultrasound?
During my Emergency Medicine at Mayo Clinic, I gained exposure to point-of-care ultrasound (POCUS) for procedural guidance. I was immediately drawn to the hands-on and technical aspects of using ultrasound, and began advancing my use for diagnostic shih purposes. After a few cases of diagnosing acute pathology at the bedside (AAA, free fluid, and DVT to name a few), I was hooked! Following residency, I decided to expand my ultrasound training and pursued an Emergency Ultrasound Fellowship at Yale, while also working toward obtaining my Registered Diagnostic Medical Sonographer (RDMS) certification. Ever since I’ve adopted a liberal use of POCUS in my clinical practice, I can say without a doubt that it’s made me a better Emergency Physician, and I can’t imagine practicing without it!

2. Talk about your role as Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto.
I’m thrilled to be able to bring the skills that I’ve learned during my own EUS Fellowship training to the Emergency Medicine community in Toronto! Our team built the Fellowship Program from the ground up, and our Department went all in with the purchase of 4 additional new ultrasound machines and QPath software for archiving. I’m truly proud of what we’ve accomplished. It certainly helps that I have an extremely supportive Department Chair and 2 amazing fellows this year!

3. What prompted the writing of your book Ultrasound for the Win!?
When trying to learn more about ultrasound myself during residency, I found that there was a void in high-yield POCUS books geared toward Emergency Physicians. I found that the few textbooks that were available, while informative, could be quite dense and intimidating to read. So I decided to develop a book that I, myself, and I believe most Emergency Physicians, would appreciate — a case-based interactive and easy-to-read format that’s clinically relevant to our daily practice. It’s a book that a medical student or resident interested in POCUS can easily read and reference during an Emergency Medicine rotation.

4. What’s one thing you learned about yourself through the writing/editing process?
It’s made me realize just how obsessed I am with ultrasound! Writing and putting together the book was hard work, but also enjoyable and extremely satisfying! Seeing these real cases compiled one after another really highlights the potentially life-saving role of POCUS in medicine, and the profound difference it can make in improving patient care and outcomes.

5. What advice would you offer medical students when it comes to ultrasound?
Scan many and scan often—it’s simple; the more you practice POCUS, the better you will be at it! Also, don’t be afraid to take initiative in your own education—while some attendings may not be comfortable enough with POCUS to teach it to you, don’t let that be a deterrent to your own learning. There’s a plethora of resources available online, including Matt & Mike’s Ultrasound Podcast and Academic Life in Emergency Medicine that you can reference!

How did you become interested in ultrasound? What are your go-to resources? What book would you like to see written? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Jeffrey Shih, MD, RDMS, is an Emergency Physician and author of the book Ultrasound for the Win! Emergency Medicine Cases. He is Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto, Canada, and Lecturer in the Faculty of Medicine at the University of Toronto. He can be reached at jeffrey.shih@utoronto.ca and on Twitter: @jshihmd

Research in Ultrasound: Why We Do It

Posted on October 25, 2016 by aium14750

“Medicine, the only profession that labors incessantly to destroy the reason for its existence.” –James Bryce

We all know the important medical discoveries clinical research has given us over time. stamatia-v-destounis-md-facr You could even make the case that the high standards of care we have today are built on centuries of research.

The world of medical ultrasound is no stranger to clinical research—dating back to the early work of transmission ultrasound of the brain. This work was especially important, as it was the first ultrasonic echo imaging of the human body.

Since then, research has brought about gray scale imaging, better transducer design, better understanding of beam characteristics, tissue harmonics and spatial compounding, and the development of Doppler. All of these research developments, as well as many others, were highly significant and have lead us to today’s high-quality handheld, real-time ultrasound imaging.

For me, the biggest and most important developments were and have been in breast ultrasound. In 1951, the research of Wild and Neal discovered and qualified the acoustic characteristics of benign and malignant breast tumors through use of an elementary high-frequency (15-MHz) system that produced an A-mode sonogram. These researchers published the results of additional ultrasound examinations in 21 breast tumors: 9 benign and 12 malignant, with two of the cases becoming the first 2-dimensional echograms (B-mode sonograms) of breast tissue ever published.

It is research that leads to landmark publications that change the way we practice. The ACRIN 6666 trial led by Dr Wendie Berg and her co-authors evaluated women at elevated risk of breast cancer with screening mammography compared with combined screening mammography and ultrasound. This pivotal study demonstrated that adding a single screening ultrasound to mammography can increase cancer detection in high-risk women. In our current environment this is even more relevant, as breast density notification legislation is being adopted in states across the country. With the legislation, patients with dense breast tissue are often being referred for additional screening services, with ultrasound most often being the screening modality of choice.

Screening ultrasound is an area on which I have focused much of my own research. I practice in New York State, where our breast density notification legislation became effective in January 2013. I have been interested in reviewing my practice’s experience with screening ultrasound in these patients to evaluate cancer detection and biopsy rates. My initial experience was published in the Journal of Ultrasound in Medicine in 2015, and supported what other breast screening ultrasound studies have found, an additional cancer detection rate of around 2 per 1000. Through my continued evaluation of our screening breast ultrasound program, I have found a persistently higher cancer detection rate by adding breast ultrasound to the screening mammogram–which is of great importance to all breast imagers, as we are finding cancers that were occult on mammography.

Participating in valuable research is important to me and my colleagues because part of our breast center’s mission is to investigate new technologies and stay on the cutting-edge by offering the latest and greatest to our patients. Participating in clinical research provides us important experience with new technology, and an opportunity to evaluate firsthand new techniques, new equipment, and new ideas and determine what will most benefit our patients. This is what I find the most important aspect of research, and why I do it; to be able to find new technologies that improve upon the old, to continue to find breast cancers as early as possible, and to improve patient outcomes.

Why is medical research/ultrasound research so important to you? What research questions would you like to see answered? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Stamatia Destounis, MD, FACR, is an attending radiologist and managing partner at Elizabeth Wende Breast Clinic. She is also Clinical Professor of Imaging Sciences at the University of Rochester School of Medicine & Dentistry.

Who Runs the AIUM?

Posted on September 27, 2016 by aium14750

Have you ever wondered what or who runs the AIUM? Of course you know about the elected officers, and the AIUM staff that works in the home office, but do you know that there are approximately a dozen committees and/or task forces that help the organization run throughout the year?

The volunteers may be elected or appointed to the committees and tasks forces, and they are not paid or compensated for their time. Frequently, there are many committee members who accept appointments and nominations year after year. Who would possibly be willing to take on extra work and added expense, just to help the AIUM?

Who are the volunteers?
Ordinary people like me! That is who! I have been volunteering with the AIUM since 2009, and have found, as they often say when you volunteer, that I get more than I give. My personal life mission is one of giving back, both to my profession and to my community. I believe anyone who volunteers for the AIUM will give you a similar answer: There is an obligation to give back because someone once gave of his or her time to help me.

How did I become a volunteer?
I did not wake up one day and think to myself, “Today is the day I should volunteer for the AIUM.” Instead, a mentor suggested to a liaison organization that I should be their representative to the AIUM Bioeffects and Safety Committee. At the first meeting, I was hooked. The work gave me new energy and excitement about my profession. I could not get enough bioeffect and safety knowledge.

When my time as a liaison ended, I asked a fellow committee member to nominate me to the committee. As luck would have it, my work proved that I was serious, and the members elected me to the committee.

How can you become a volunteer?
Maybe you are thinking to yourself right now, I am energetic and have a lot to give, but I do not know how to get involved. What should I do? If you have a mentor in the AIUM, ask him or her to nominate you to a committee.

If you do not have a mentor I suggest that you start by serving as a resource member to the committee that best matches your skills and interests. A resource member might assist the members on projects. You can offer up your talents by contacting the chair and letting him or her know that you want to help. Once your work is visible, you can ask a member to nominate you to be a committee member.

You Get More Than You Give
I have gained so much from working on a committee. I have new knowledge about bioeffects and safety that has allowed me to take on a larger advocacy role. I have new knowledge to integrate into the courses that I teach, and I have developed lectures to educate all medical imaging professionals about ultrasound bioeffects and safety. The work on the committee has inspired my own research projects that have resulted in award-winning manuscripts.

My confidence in my knowledge has improved, and I am willing to try new and difficult projects that I would not have dreamed of trying in my pre-committee life. I have made friends and have gained new mentors. I know that regardless of how much effort I have given, the committee has given me exponentially more.

Member, Pay it Forward!
None of us ever gets where we are on our own. In addition to our hard work, our mentors and our colleagues help us on our professional journeys. Volunteering is a way to pay it forward.

If you are an active volunteer, now is the time to make sure your good work is continued! Mentor a new member, and help him or her get involved. Suggest that he or she become a resource member or nominate him or her to a committee. Bringing new people into the volunteer world ensures that your good work continues, and it provides for the AIUM’s future.

What has been your volunteer experience? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer Bagley, MPH, RDMS, RVT, is an associate professor for the College of Allied Health at the University of Oklahoma Health Sciences Center, Schusterman Campus in Tulsa. She currently serves on the AIUM Bioeffects Committee and is a former member of the Technical Standards Committee.

My Chilean Experience

Posted on September 13, 2016 by aium14750

Earlier this year, I had the opportunity to travel to Chile to present at the 18^th Congress of Medical Technology meeting in Santiago. It was an amazing experience that I will never forget! The total travel time was about 14 hours, which began in Orlando with a flight delay and an emergency change to an earlier flight that had one seat left and was just about to
close its doors! Chile

Sonographers, as well as other allied health professionals, begin their education in the Colegio de Tecnologos Medicos (College of Medical Technologies); and the Capitulo de Ecografia (Sonography Chapter) is an arm of the College. It is estimated that there are about 300 sonographers in the country of Chile. I was invited to speak at the meeting of the congress and the preconference, which was the inaugural meeting of the Sonography Chapter.

The evening before the preconference, I was invited to meet with a group of sonographers at a reception to discuss professional issues, certification, and education. The reception was hosted by the President of the College of Medical Technologies, Veronica Rosales, and the President of the Sonography Chapter and AIUM member, Mario Gonzalez Quiroz. At the reception, I was introduced to Fernando Lopez, known as the first sonographer in Chile with about 30 years of experience. I found the sonographers of Chile to be very welcoming and gracious, as well as curious about the role of sonographers in the U.S. They are also eager for educational opportunities to expand their knowledge and expertise.

I gave a total of 6 lectures during the 2 meetings on a variety of topics, including point-of-care, acute abdomen, obstetrical pathology, and pediatric sonography. Oh…did I mention that I don’t speak Spanish? I had synchronous translation of my lectures, and then I was able to enjoy other lectures that were then translated into English for me. As I was developing my lectures, I learned that with asynchronous translation, presentations should be shorter and you need to speak slowly. For me, that meant I had to reduce my typical image-heavy 100-120 slide presentation down to 70-80 slides. Luckily that worked within the time I was given.

This was my first time having lectures translated, my first international lectures, and my first time in Chile (actually my first time in South America)…lots of firsts! It was a true honor to present at this meeting and to meet the sonographers of Chile. I feel like I have made lifelong friendships, expanded my professional family, and experienced the beauty of a new country.

Have you given talks to an international audience? What was your experience? How can U.S.-based physicians and sonographers support their counterparts in other countries? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Charlotte Henningsen, MS, RT(R), RDMS, RVT, is the Chair & Professor of the Sonography Department at Adventist University of Health Sciences and the Director of the Center for Advanced Ultrasound Education. She currently serves as the AIUM 2^nd Vice President.

The Scan

The official blog of the AIUM

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