FOAMed Made Me A Better Lecturer

Posted on August 16, 2016 by aium14750

My glossy, relentless smile slowly began to sag. My enthusiasm waned. I asked myself, “Why are you even here?”

Although that was the first time I actually asked the question, truth be told, it had been germinating in my brain for the past few months. FullSizeRender

It was during one particularly bland and unprepared lecture in my first year of medical school when I found it nearly impossible to read the deluge of text on the PowerPoint slide and listen to the speaker. Not only was I quickly losing interest, but the speaker appeared to be caught off guard by the content of his own slides. The phrase “Why did I put that in this slide?” was uttered over and over again. Unfortunately, my despair was not limited to this one professor or this one lecture. In fact, getting a good lecture was more outlier than standard.

It was at that moment I decided to stop attending lectures. I figured since the speakers gave me access to their slides and all they were doing in class was reading the slides, I could stay at home and do just as well. As validation for this theory, my grades improved.

Shortly after graduating medical school, I was asked to give my first lecture as an intern. What did I do? I created a PowerPoint with bullets. That lecture went over about as well as those medical school lectures did: horribly.

While the content was acceptable, the presentation wasn’t engaging, and worst of all, it was boring. I found myself perpetuating the cycle and becoming a part of the problem rather than a solution.

For my next lecture, instead of focusing on the required content, I focused on my audience. Luckily I had a group of mentors who had grappled with this so I began to study not only the content of their lectures but also how they lectured.

Soon after, I discovered podcasts and the #FOAMed (Free Open Access Medical Education) movement. Inexplicably, I found I could watch an entire 20-minute talk online without checking my phone. For someone with the attention span of a small bird, this was no small feat.

I tried to emulate what I had been learning and observing for my next talk, and when I gave my next lecture to the residents, I found they were spending less time on their phones and computers and more time engaged in my lecture. After that experience, I immediately asked for more opportunities to lecture because I knew the only way to improve was to do more of them. While the residency was very accommodating, they were only able to give me a lecture every couple of months, and I needed more.

Since I couldn’t give lectures to our residents as frequently as I desired, I thought maybe I could practice on my computer. Initially, I figured I could record a few lectures and put them on YouTube. But the more I thought about it, the more I wasn’t sure this is how I wanted to distribute my content. I always got distracted when I went on YouTube. I would start looking for ultrasound videos and then somehow end up watching an hour of compilations of cats falling asleep and rollerbladers falling.

That’s when I thought about creating a website. I wanted a place where I could upload all of my lectures in an easy-to-navigate format, with minimal distractions. I remember reading somewhere that the average student attention span was approximately 10 minutes, so decided I was going to try and make my videos 5 minutes long to increase the likelihood that people would actually watch the whole video. That’s where 5-minute sono was born.

Eventually I purchased a USB microphone and paid for good screen capture software and began recording. Initially I wanted to focus on purely instructional videos without any mention of the evidence or current literature. This made it much easier to keep my content as short as possible, with the long-term plan to create a podcast where I could talk about literature as much as I wanted. Setting up a website to look good and work seamlessly is very difficult. Thankfully the ultrasound director where I went to residency is kind of a genius on that front. There have definitely been a few hiccups along the way, but overall the experience of been pretty amazing. This has taken a tremendous amount of work, but viewership has been steadily increasing, which is encouraging. I still have a large amount of instructional 5-minute sono videos to create, but decided to start introducing more literature reviews in the form of a blog and podcasts. Soon I’ll begin my faculty position at the University of Tennessee in Chattanooga, Tennessee, Department of Emergency Medicine, and anticipate I’ll be able to lecture to the residents to my heart’s content. But that won’t stop me from continuing the steady stream of ultrasound instructional videos and supporting the FOAMed movement.

How do you make your talks more engaging? What are your favorite FOAMed resources? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jacob Avila, MD, is Co-fellowship and Ultrasound Director, Clinical Assistant Professor at the University of Tennessee in Chattanooga, Tennessee. To check out some of his FOAMed material, visit 5 Min Sono.

How to Obtain Focused Cardiac Ultrasound Images

Posted on August 2, 2016 by aium14750

My first exposure to handheld ultrasound was as a first-year medical student. I was assigned to a cardiology clinic with an attending that pioneered handheld ultrasound examinations. Watching him move from patient to patient and use ultrasound to simultaneously diagnose and teach inspired me to learn how to use ultrasound and incorporate it into my practice.

Parasternal long axis demonstrating a dilated left ventricle.

As a budding cardiologist, examining and triaging patients with handheld ultrasound is a part of my daily work. Although handheld ultrasound and the stethoscope differ vastly in their technology, at the bedside, both are limited by the user’s interpretation of the examination findings. I have found when using handheld ultrasound, as with the stethoscope, perhaps the most important tool is “between the ears.”

The “Introduction to Focused Cardiac Ultrasound” set of lectures provide an overview to focused cardiac ultrasound views and a guide to obtain them. The main goal is to develop an understanding of the scope of focused cardiac ultrasound and to “get the heart on the screen” when scanning. The first lecture focuses on the parasternal long axis and subcostal views of the heart. In practice these views will often be the most helpful and accessible. The second lecture reviews the parasternal and subcostal views and introduces the apical views of the heart. Each lecture includes sample diagnoses.

My rationale for reviewing all the basic views of the heart is to provide a broad survey of all the windows and probe orientations. When a formal cardiac echo is ordered, these are the views and windows obtained by the sonographer. In practice with handheld ultrasound, one or two of these views can be utilized to answer the question at hand. Based on patient positioning and body habitus, however, certain windows may provide a better view of the heart.

My hope in sharing all the views in the second lecture is to not overwhelm the learner but rather provide a strong foundation in understanding the anatomical relationships of the ventricles and atria in the body and see how one window builds off the next. The views in this lecture are directly applicable to structured bedside ultrasound examinations, such as the “CLUE examination.”

At our home institution, we utilize these lectures in a continuously rolling small-group lecture series for our medical students and house staff. The cardiology fellow leads the lecture and the hands-on scanning portion, rotating every third week on the step-down cardiology unit. Overall the feedback has been positive with many of the trainees spreading the skills to other rotations. We are happy to share this resource and welcome feedback.

What resources are invaluable to you? What tools do you use to continually learn? Where do you find the information you need? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Colin Phillips, MD, is Fellow, Division of Cardiovascular Disease at Beth Israel Deaconess Medical Center.

A Word of Encouragement

Posted on May 10, 2016 by aium14750

One excellent online teaching tool for emergency ultrasound states that “scientists have been fascinated by the mechanism of acoustics, echoes and sound waves for many

Attendees get hands-on experience at AIUM’s Wake Forest

centuries.”

I am not one of those scientists.

Frankly, I don’t like physics. I find it challenging to understand things I can’t see. Take gravity, for example. I know and can tell quite distinctly that it exists. The scar on my shin following a childhood attempt at flight is a faithful reminder of its existence. It still remains hard for me to understand the intricacies of this force because of its invisibility. To me, this is similar to a lot of physics concepts.

It’s therefore hilarious that I was somehow drawn to ultrasound. It must have been the enticement of being able to see more, although the ability to “see” is granted by what is unseen—ultrasound waves. The joke was definitely on me.

So how did I get here?

My journey with point-of-care ultrasound (POCUS) started with a remark by a friend of mine. At the time, she was an emergency medicine resident and she told me about a trauma patient that she had performed a “FAST” on. Close to completing 3 years of Pediatric residency, I had never heard of such a thing. I remained intrigued with the idea of quick decision-making scans performed by the provider actively involved in the patient care. Who wouldn’t want this given the chance? The challenge of course lies in acquiring the knowledge.

Things now got interesting.

During my Pediatric Emergency Medicine (PEM) fellowship, I sought to learn more about POCUS. My initiation was not spectacular to say the least. The words of my instructors bounced off the surface of my brain with very little being absorbed. This would have been OK if I were an ultrasound machine. It wasn’t very good when trying to learn how to obtain and interpret ultrasound images however.

By the second and third lesson, I was convinced that I would never learn ultrasound. But as in the majority of love stories, persistence paid off.

Gradually my images changed from what resembled a 1970s television screen after midnight to recognizable structures. By the end of my PEM fellowship, I had acquired a few rudimentary skills. I took an opportunity to pursue an Emergency ultrasound fellowship immediately after my PEM fellowship and the dread of my early ultrasound learning days came upon me again. So many applications, so little understanding.

One day as I scanned a patient, “Eureka!” I finally understood the parasternal long axis. There was hope for me yet.

How did I finally get here?

Persistence – The old adage holds true. If at first you don’t succeed, try, try again.When the words or explanation didn’t make sense, I would try a video (YouTube has some great videos). I would get models of structures to understand the anatomy and relate to them to my scans. I would seek out others to explain concepts in different ways to help my understanding.
Memorization – This provided a foundation and served as the means to the end. When using POCUS, there is a lot to remember and you have to put in the necessary study time.

Finally, I was able to understand what was going on and what the picture was telling or NOT telling me. I also learned not to beat myself up for not understanding everything. That is what colleagues, mentors, online resources, and practice are for.

I now understand a lot of POCUS–more than I ever imagined or thought possible. I didn’t let my dislike of physics or the challenge of image recognition stop me. I figured if others could learn this, I should at least give it a decent shot. And that’s what I ask of those I teach or anyone interested in learning.

What would you tell someone starting to learn ultrasound? What aspect was most difficult for you? How did you overcome it? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Atim Uya, MD, is the Point of Care Ultrasound Director, Division of Emergency Medicine, Department of Pediatrics, University of California, San Diego/Rady Children’s Hospital, San Diego, California.

Pediatric Emergency Ultrasound: We’ve Come a Long Way, Baby

Posted on April 26, 2016 by aium14750

My first rotation as a pediatric emergency medicine (PEM) fellow was on the adult trauma service. It was 2006 and in West Philadelphia there was no shortage of patients with gun shot wounds, stabbings, and motor vehicle crashes. The trauma surgeons were hard on the surgery trainees, and generally nice to the PEM fellows. We weren’t training to be surgeons on the front line after all. One attending, however, was indiscriminate in his wrath and unbiased in his intent to humiliate.

dreamstime_xs_59669332 A few days into the rotation, during a trauma alert, he chose me: “Jennifer, the FAST, do the FAST!” I was completely puzzled and looked at him blankly. This, of course, made him angrier. “Do the FAST exam!”

Unable to admit at the time that I had never heard of the FAST exam, I remained silent. Seeking to avoid any fear, shame, or humiliation that would certainly accompany future traumas, I immediately read everything I could about it, and the surgery fellows taught me at the bedside.

I returned to the children’s hospital wanting to learn more about ultrasound. Unfortunately, at the time, no one in PEM knew much about it. In fact, none of my colleagues or mentors had any experience with it. I sought guidance from my general emergency medicine colleagues next door who welcomed me and trained me as one of their own.

In time, I proposed a research study in the pediatric emergency department: point-of-care ultrasound for pediatric soft tissue infections. At the time, the radiology faculty weren’t keen on this. They were unaware of non-radiologists using ultrasound and didn’t understand why emergency physicians would need to use it. It was a slippery slope, they argued, and might result in indiscriminate and “unregulated” usage. We compromised–I could use ultrasound in the emergency department solely for research purposes. The machine, literally under lock and key, was off limits to anyone but those involved in the study.

As I found out, my experience was not unique. Many of my PEM colleagues around the country faced similar obstacles from specialists outside of the emergency department. Point-of-care ultrasound at that time was simply not the standard of care.

Nearly a decade later, I practice in a very different climate. Point-of-care ultrasound is a mainstay in my patient care practice; and I now have the support (and collaboration) of my radiology colleagues and others outside of emergency medicine.

More broadly, PEM ultrasound is a recognized subspecialty. Notably:

There are approximately 10 dedicated 1-year fellowships in pediatric point-of-care ultrasound.
Pediatric point-of-care ultrasound is part of the American Board of Pediatrics core content for pediatric emergency medicine fellowship training, and has been incorporated into the PEM subspecialty board examination.
Landmark publications include the American Academy of Pediatrics Policy Statement and Technical Report for PEM point-of-care ultrasound.
There is a PEM ultrasound international organization (www.p2network.com).
AIUM invited me to write this blog.

We certainly have come a long way.

Do you have a similar ultrasound story? What other areas have come a long way when it comes to ultrasound? What areas are poised to be next? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer R. Marin, MD, MSc, is Director of Emergency Ultrasound in the Division of Pediatric Emergency Medicine as well as Quality Director, Point-of-Care Ultrasound at Children’s Hospital of Pittsburgh of UPMC.

AIUM Annual Convention Rocks NYC

Posted on March 28, 2016 by aium14750

aium16 Last week, physicians, sonographers, scientists, and educators from across the country and around the world left New York City and the AIUM Annual Convention to return home. They left with new contacts, tips, tricks, techniques, research, technology, and information that will help them improve patient care. If you were unable to attend, or if you want to relive another amazing AIUM Annual Convention, here are the highlights as well as a summary of attendee feedback.

The Highlights

SonoSlam—In its inaugural year, this student competition had 16 teams sign up to compete for the Peter Arger Cup. This year’s winning team, “Baby Don’t Hertz Me,” hails from The Ohio State University. Plans are already underway to increase this event next year.
Awesome Plenary—The ballroom was packed for the Opening Plenary session that featured an engaging talk by Alfred Abuhamad, MD, titled, “Global Maternal Health: Ultrasound and Access to Care.” Attendees also heard from William J. Fry Memorial Lecturer Dirk Timmerman, MD, PhD, FRCOG, on “Tips and Tricks of Successfully Ultrasound Studies.”
Sold-out Exhibit Hall—Spread over two floors, this year’s exhibit hall featured a wide variety of companies that collectively addressed nearly every ultrasound need. This year several exhibitors offered great deals and amazing drawings.
Ultrasound for Every Specialty—Attendees raved about the mix of specialty sessions throughout the Annual Convention. In fact, this year the content included sessions from 18 different ultrasound specialties.
Award Winners—AIUM was proud to recognize the following award winners (look for upcoming blog posts from these individuals):
- Alfred Abuhamad, MD—Joseph H. Holmes Clinical Pioneer Award
- Michael Kolios, PhD—Joseph H. Holmes Basic Science Award
- Christian Fox, MD, RDMS—Peter Arger Excellence in Medical Student Education Award
- Daniel Merton, BS, RDMS—Distinguished Sonographer Award
- Aris Papageorghiou, MD—Honorary Fellow
- Paul Sidhu, BSc, MBBS, MRCP, FRCR—Honorary Fellow
Social Media—This year was by far the most active year for #AIUM16 on social media. On Twitter alone there were double the number of impressions over last year, with nearly 500 people participating.
E-poster winners—Every year, the AIUM supports an e-poster program. This year, the winners were (look for upcoming videos from them):
- First place:A Comparison Of Different Hydrophones In High Intensity Ultrasound Pressure Measurements by Yunbo Liu and Keith Wear
- Second place: Sonographic Evaluation of Ligaments and Tendons of the Hands by Jonelle M. Thomas, Cristy Gustas, and Dylan Simmons.
- Third place: Can You Give Me a Hand? Diagnosing and Understanding the Clinical Significance of Fetal Hand Anomalies in Obstetric Ultrasound by Karen Oh, Thomas Gibson, Kathryn Snyder, Ryan Meek, and Roya Sohaey.
- Honorable Mention: The Neck is More than the Thyroid Alone: 3-D Ultrasound of Cervical Lymph Nodes, Salivary, and Parathyroid Glands, Palpable/Visible Abnormalities by Susan Judith Frank, David Gutman, and Tova Koenigsberg.
Up and Comers—AIUM recognized 4 outstanding papers in its New Investigator Program.
- Basic Science Winner: Aiguo Han for Structure Function for Quantitative Ultrasound Tissue Characterization
- Clinical Ultrasound Winner: Margaret Dziadosz for Uterocervical Angle: A Novel Ultrasound Marker to Predict Spontaneous Preterm Birth
- Honorable Mention: Mahdi Bayat for Comb-Push Shear Elastography on a Clinical Ultrasound Machine: First Report on Differentiation of Breast Masses
- Honorable Mention: Xueqing Cheng for Effect of Percutaneous Ultrasound-Guided Subacromial Bursography With Microbubbles for Assessment of Rotator Cuff Tears

We know that everyone has their own highlights from this event. If you want to share yours, please do so on Twitter @AIUM_Ultrasound.

The Feedback

The AIUM Annual Convention is the largest event supported by the organization. full session As such, we realize that while most things go well and according to plan, some do not. Here then is
the feedback attendees have shared with the AIUM.

94% said overall the Convention was Good or Excellent. This was the same as the past 2 years.
56% of attendees said the registration and pre-registration process was Good or Excellent.
Nearly 90% of attendees said they would make at least some modification to how they practice ultrasound as a result of what they learned at the AIUM Annual Convention. This was up from the 70% that said the same last year.
96% of attendees said they would recommend the AIUM Annual Convention to a colleague. Again, this was an increase over last year’s 91%.
91% of attendees said the AIUM Convention was either on par or better than other ultrasound courses/events they have attended. This is another increase over last year’s 90%
More than 80% of attendees said it was highly likely they would attend another AIUM Annual Convention.

As for the areas that need more attention and work, here is where the pain points were:

Elevators—Some floors experienced long wait times for elevators. Several attendees expressed frustration at having to make choices based on how long the elevator would take. We completely understand and all hotel-related comments will be shared with the hotel staff.
Cost—This continues to be an issue and is one that the AIUM Executive Committee is taking very seriously. The AIUM is exploring a number of models and programs to help reduce the cost of attending this event.
Overlap of sessions—Many attendees shared that sessions they wanted to attend were overlapping. With such a diverse offering of sessions, this is bound to happen to some extent. This year, the AIUM did record all the lectures. We will be making them some of them available through the online communities and other available for CME credit. These videos will be released over the next couple of months.
Technological issues—Some presentations experienced technical difficulties. Much of this was related to the fact that our service provider was operating a newer version of software than most of our presenters were using. In the future, the AIUM will share that information with presenters in an effort to reduce these issues.

The Praise

Despite some of the hiccups, most attendees spoke glowingly of the 2016 AIUM Annual Convention. Here is just a sampling of the comments we received:

“The courses were excellent in OB/GYN — all fantastic!!!”
“Excellent sessions, great speakers, tremendous choice”
“The 30-minute lectures; presentation of cases. Lunch was great! Loved the special sessions.”
“I was very impressed with the content, subject matter, and quality of the presentations of the conference. I’d never planned to come to AIUM before and came only because it was close to where I practice. I will be back!”
“I am new to this field so was just excited to hear all the exciting work going on. I liked the size of the convention in general.”
“Seems culture is changing to become more welcoming of new ideas and collaborative.”
“The opportunity to learn ultrasound from multiple specialties with their different areas of focus and expertise. Courses run by speakers from multiple specialties provided different insights and perspectives.”
“Great people involved, SonoSlam was super fun, I enjoyed several of the didactic sessions.”
“The hands-on fetal echo course with Dr. Solomon was excellent. Wish I could work with her for several weeks.”
“I really liked that this conference could bring together many disciplines. I like the way the format was laid out by interest. Worked very, very well.”

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 2016 Annual Convention is over, we are already hard at work on the 2017 Annual Convention that will be held March 25-29 in Orlando.

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.

How I Became Involved in Dermatologic Ultrasound

Posted on December 1, 2015 by aium14750

There are certain moments in time when your gut tells you that your life is about to change. It happened to me in 1999.

I was on a training visit to the Musculoskeletal Ultrasound Section of the Department of Diagnostic Radiology at the Henry Ford Hospital in Detroit when Dr Wortsman I saw a “hockey stick” probe. Instinctively, I decided to use it on my fingernails. The images I saw on the screen were so fantastic that I ran to the library to see if there were any papers or publications that focused on ultrasound of the nail.

Surprisingly, I discovered a few Italian and Danish dermatologists who were working with smaller types of high frequency ultrasound devices on experimental settings. Wanting to learn more, I wrote to them. I was thrilled when Professor Gregor Jemec responded and agreed to collaborate.

However, getting an ultrasound machine for a dermatology project proved to be more difficult. It took almost 2 years before an ultrasound machine was installed and available for me to use while I was at the Department of Dermatology at Bispejerg Hospital in Copenhagen.

After securing the machine, I had the opportunity to scan dermatologic patients on a daily basis and I realized the great potential this imaging modality had within dermatology.

Once I returned to Chile, I really got to work. I studied the sonographic patterns, began to correlate the ultrasound images with the clinical and histologic findings, and started to publish the results.

That also proved difficult at first because radiology journals felt the content was better suited for dermatology journals and dermatology journals recommended radiology journals since the content involved imaging. Probably these journals had a difficult time even finding someone to review this material.

It was during this rough beginning that I reached out to my uncle Jacobo. I was telling him how difficult publishing could be and he simply reiterated President Truman’s famous quote, “If you can’t take the heat, get out of the kitchen.”

That just made me more committed. I created an educational website and continued to practice, learn, research, and write. In 2010, the Journal of the American Academy of Dermatology published our paper that analyzed more than 4,000 dermatologic ultrasound cases with histologic correlation. In 2013, our book Dermatologic Ultrasound with Clinical and Histologic Correlations was published.

Since that time, a lot has changed. I used to hear radiologists and dermatologists comment that they had never heard of dermatologic ultrasound. Now, the use of ultrasound in dermatology is expanding rapidly with colleagues from around the world using this tool to diagnose common dermatologic conditions earlier and more precisely.

For me, the dermatologic ultrasound journey mirrored my family’s immigration journey. We both left something familiar and ended up in a distant land. While the journey has not been easy, the results have been more than worthwhile.

But our work continues. Now, one of our challenges is how to share what we have learned to inspire and train a new generation of dermatologic ultrasound professionals. As a specialty, we are excited by AIUM’s support through the development of a dermatologic ultrasound interest group. Here we will share information, research, and resources. Please join us!

Why did you becoming interested in ultrasound? Have you participated in your AIUM Community? What struggles have you overcome in your career? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Ximena Wortsman, MD, Radiologist, Chair of Dermatologic Ultrasound AIUM Interest Group, Senior Member of AIUM, Department of Radiology and Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.

Medicine, Music, and Moonlighting

Posted on September 29, 2015 by aium14750

I love my day job as a gynecologic oncologist at Princess Margaret Cancer Centre in Toronto as well as my role as the clinical lead for Royal Victoria Regional Health Centre regional gynecologic cancer program in Barrie, Ontario. My work keeps me very busy as do my three beautiful daughters. With great friends and family, and some of the best support staff any doctor could ask for, I’ve achieved my goal of becoming a successful doctor and surgeon for women with cancer. But I’ve always had another dream tucked away.

Dodge 2 I’ve always been musical – in fact at age 3 I started playing the accordion, which I’m pretty sure was bigger than I was! But I put my musical dreams on hold while I pursued a medical career. I learned to play piano, percussion, and brass, and dabbled with songwriting over the years but most of my time was devoted to my medical training at Western University and University of Toronto.

A few years ago a patient in the palliative care ward asked me to play for her. I brought in my piano and surprised her with an original song I’d prepared for her titled, “It’s So Hard to Say Goodbye.” It was an emotional afternoon and afterward she made me promise that I would pursue my love of music professionally. Well, two albums later, here I am working on my third with two very accomplished and talented songwriters, Steve Dorff (whose songs have been sung by legends Barbra Streisand, Celine Dion, and Whitney Houston, to name a few) and Paul Overstreet (who wrote the number-one hit “Forever and Ever, Amen” for Randy Travis).

Many people ask me how I find the time to be a doctor at two hospitals and a professional musician.

Sometimes after a challenging day at the hospital, it can be hard to do anything at all, let alone write and play music. But music never feels like a chore. It calms my spirit and brings me a sense of peace. I find that music has a unique healing power both for me and for people going through tough times, whether struggling with illness or other personal issues. I always say that my goal is to share my music with as many people as possible with the hope that it will bring to them the same sense of passion, peace, and fulfillment it has brought to my own life. Here are a few ways in which music helps to heal both patients and myself.

How Music Helps Patients

Pain relief
Overall, music does have positive effects on pain management. It can help reduce both the sensation and distress of chronic pain, postoperative pain, and a range of conditions, according to a paper in the Journal of Advanced Nursing.
Immunity boost
Music can boost the immune function. A comprehensive study on the neurochemistry of music explains that a particular type of music can create a positive and profound emotional experience, which leads to secretion of immune-boosting hormones as well as endorphins. Listening to music, dancing, or singing can also decrease levels of the stress-related hormone cortisol.
Increase energy and fight fatigue
Many of my patients sometimes suffer from fatigue due to treatment or the postoperative healing process. Losing themselves in music helps reduce physical and emotional stress and can chase negative emotions away. Musical distraction can also help with sleepless nights.

How Music Helps Me

Staying positive
Music improves my moods and creates a more positive state of mind that helps me through busy days and emotional times.
Mental and physical workout
Music helps with concentration and staying focused. In addition, playing the piano improves motor coordination and dexterity – very beneficial when I’m at the operating table.
Calm and cool
The medical field can be very high-stress and emotionally taxing. Going home and playing the piano or writing lyrics really helps me channel this energy in a positive way. And music has been shown to help lower heart rate and blood pressure, which is great for my long-term health.

How does music affect you? What activities help you escape? How do you balance the demands of the job with your personal interests? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jason Dodge, MD, Med, is a surgical oncologist at Princess Margaret Cancer Centre in Toronto. He participated in the AIUM International Consensus Conference on Adnexal Masses in 2014. You can check out his music on his website or on iTunes.

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.