Tag Archives: POCUS

Empowering OB/GYN Trainees Through Point-of-Care Ultrasound: Bridging Imaging and Clinical Care

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Point-of-care ultrasound (POCUS) has rapidly become an essential advancement in modern clinical practice. By bringing real-time imaging directly to the bedside, POCUS allows the same clinician who examines the patient to also visualize anatomy, assess pathology, and immediately act on findings. This integration of imaging and decision-making has made POCUS indispensable across multiple specialties, and obstetrics and gynecology are no exception.

The American Institute of Ultrasound in Medicine (AIUM) has long recognized the importance of standardization and quality in ultrasound practice. Its Practice Parameter for the Performance of Point-of-Care Ultrasound1 provides clear specifications for evaluating the abdomen, retroperitoneum, thorax, heart, and extremities for deep venous thrombosis. These guidelines form the foundation for ensuring that the benefits of POCUS—speed, accuracy, and accessibility—are balanced with safety and quality.

POCUS in Everyday OB/GYN Practice

Within obstetrics and gynecology, POCUS is a natural extension of bedside care. On labor and delivery units, it enables rapid assessment of fetal presentation, amniotic fluid, and placenta and fetal well-being through biophysical profiles. In emergency and postoperative settings, clinicians can use POCUS to quickly evaluate for intraperitoneal free fluid, aiding in the diagnosis of ruptured ectopic pregnancy or postoperative bleeding.

Evidence continues to support the diagnostic reliability of POCUS in OB/GYN. For instance, Boivin et al2 evaluated its accuracy in diagnosing retained products of conception in 265 patients. They found that point-of-care ultrasound demonstrated a sensitivity of 79% and specificity of 93.8%, validating its value in streamlining diagnosis and guiding timely management.

Training Gaps and the Case for Structured Education

Despite its broad applicability, ultrasound training in OB/GYN residency and MFM fellowship remains highly variable. Currently, emergency medicine is the only specialty with formal requirements for ultrasound training and credentialing. This gap has led to inconsistent proficiency among new OB/GYN graduates, even though ultrasound is fundamental to the specialty.

A structured curriculum in POCUS can address this gap. Training should combine didactic instruction, hands-on scanning, and supervised image review, building both technical skills and diagnostic reasoning. Defining competency benchmarks and maintaining image portfolios reviewed by credentialed sonographers or MFM faculty can help standardize skill acquisition and ensure quality.

Expanding POCUS Applications in Obstetric Critical Care

POCUS offers unique advantages beyond fetal and gynecologic imaging, particularly in the management of acutely ill obstetric patients. In the setting of hypertensive disorders, sepsis, or peripartum cardiomyopathy, bedside ultrasound can provide immediate insights into maternal cardiopulmonary status.

  • Lung ultrasound helps identify pulmonary edema, distinguishing cardiac from non-cardiac causes of dyspnea.
  • Cardiac views allow assessment of contractility and pericardial effusion.
  • Inferior vena cava (IVC) measurements help estimate fluid status and guide resuscitation in acutely ill patients.

Learning Early, Learning Effectively

Training in ultrasound doesn’t have to wait until residency. Vyas et al3 demonstrated that even first-year medical students could perform a basic obstetric triage scan after only twelve hours of training. Students correctly identified fetal lie, placental location, amniotic fluid index, biparietal diameter, and head circumference in more than 90% of cases, showing that structured, feedback-driven instruction can produce reliable results even among novice learners.

Sustaining Competence Through Practice

Ultrasound is a skill that requires repetition, reflection, and review. A comprehensive program should integrate longitudinal opportunities for scanning, image storage, and expert feedback. Access to curated image archives can help trainees build pattern recognition and diagnostic confidence. Incorporating POCUS assessments into rotations, such as emergency triage, obstetric critical care, or ultrasound electives, reinforces learning through real-world application.

Conclusion

Point-of-care ultrasound represents both an art and a science, merging clinical intuition with immediate visual data. For OB/GYN residents and MFM fellows, POCUS is not simply a diagnostic adjunct but a core competency that enhances patient safety, efficiency, and confidence at the bedside.

By embedding structured POCUS training and competency assessment into OB/GYN education, we can ensure the safe and effective use of ultrasound in medicine. Doing so ensures that the next generation of clinicians will not only interpret images but truly see their patients more completely, more immediately, and more compassionately.

References

1. American Institute of Ultrasound in Medicine. AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. J Ultrasound Med 2021; 40(8):E34–E52. https://doi.org/10.1002/jum.14972

2. Boivin J, et al. Utility of Point-of-Care Ultrasound in the Diagnosis of Retained Products of Conception. J Obstet Gynaecol Can 2020; 42(4):440–446. https://doi.org/10.1016/j.jogc.2019.08.026

3. Vyas KS, et al. Point-of-Care Obstetric Ultrasound Training for First-Year Medical Students in Rural Settings. J Ultrasound Med 2018; 37(3):715–722. https://doi.org/10.1002/jum.14404

Ruchira Sharma, MBBS, MD, FACOG, is a Maternal-Fetal Medicine Specialist, Director of MFM Fellowship, and Director of the Obstetric Ultrasound and Antenatal Testing Unit at Rutgers Robert Wood Johnson Medical School.

Sara Buhmaid, MD, is a Maternal-Fetal Medicine Fellow at Rutgers Robert Wood Johnson Medical School.

A professional headshot of a smiling woman with shoulder-length dark hair, wearing a patterned blouse and a dark blazer, against a blurred blue background.
Ruchira Sharma, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. 10/25/2021 Photo by Steve Hockstein/HarvardStudio.com

Recommendations for Improved Safety of Lung Ultrasound

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Lung ultrasound (LUS) has been emerging as a vital clinical tool. LUS aids in diagnosing a range of conditions, from pneumonia to respiratory distress syndrome or pulmonary edema. LUS was also very significant at the height of the COVID-19 pandemic, when point-of-care lung monitoring modalities were crucial.  

Diagnostic ultrasound standards and safety guidelines were established in the late 20th century to ensure the safety of ultrasound imaging and avoid ultrasound bioeffects in tissues. The Thermal Index (TI) and Mechanical index (MI) are two ultrasound exposure indices that respectively indicate the risks of tissue heating and cavitation and which must be displayed in real time during scanning. However, the lung is a tissue like no other, and the bioeffects observed in animal studies (in mice, rabbits, pigs, and monkeys) are very different from the bioeffects observed in other tissues. Capillary pulmonary hemorrhage is a unique bioeffect that is correlated to the MI. In order to avoid such specific ultrasound bioeffects, a new safety paradigm must be created for LUS.

Despite guidelines recommending MI ≤ 0.4, recent research suggests that a further reduction to MI ≤ 0.3 for enhanced safety might be needed. In addition, it is critical to account for the actual MI in situ, which is influenced by the thickness of the chest wall. This is particularly concerning in neonatal LUS safety, due to thin chest walls and intensive use.

Existing safety education varies among practitioners, and surveys indicate a lack of knowledge regarding lung ultrasound safety. In the absence of an appropriate preset, pre-installed on all machines, for neonatal LUS guaranteeing an MI ≤ 0.3, the risk of error and exposure to higher MI is significant. In pediatric and adult patients with a thicker chest wall, a higher MI would be acceptable, as long as adherence to the “as low as reasonably achievable” (ALARA) safety principle is maintained.

Overall, the recommendations for Improved Safety  of Lung Ultrasound are:

  1. To install a preset on all ultrasound machines limiting MI to ≤ 0.3 for neonatal cases.
  2. To provide a user-friendly means for practitioners to select the safety preset without manual adjustments.
  3. To allow higher MI values for pediatric and adult patients when needed for optimal imaging, considering higher ultrasound attenuation in thicker chest walls.
  4. To guide practitioners in adhering to the As Low As Reasonably Achievable (ALARA) principle and by considering the chest wall attenuation for MI > 0.3.
  5. To develop a specific Mechanical Index for Lung (MIL). The creation of a unique MIL for LUS, displayed on-screen to estimate pleural exposure accurately would increase safety and safety awareness among practitioners.

Enhancing safety in LUS requires a multifaceted approach, encompassing preset implementation, practitioner education, and technological advancements. The proposed recommendations aim to address current safety challenges, ensuring the continued effectiveness and safety of lung ultrasound in diverse clinical settings and for diverse populations (from neonates to high BMI patients). By combining technological innovations with user-friendly controls, the proposed safety paradigm seeks to strike a balance between optimal imaging outcomes and patient safety in the evolving landscape of LUS.

For more information, see the “Statement and Recommendations for Safety Assurance in Lung Ultrasound” from the American Institute of Ultrasound in Medicine (AIUM)

Marie Muller, PhD, is an Associate Professor of Mechanical and Aerospace Engineering at NC State University.

Exploring the Future of Ultrasound: 5 Trends to Watch

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Ultrasound technology has come a long way since its inception and continues to evolve at a rapid pace. As we look ahead to the near future, it’s clear that ultrasound will play an even more vital role in healthcare. In this blog post, we’ll explore 5 trends (in no particular order) that are set to shape the field of ultrasound in the coming years.

1. Portable and Handheld Ultrasound Devices

The trend of portable and handheld ultrasound devices is on the rise. In the past, ultrasound machines were hundreds of pounds, carted around on wheels, and costly to manufacture. These new, compact, and lightweight devices offer healthcare professionals the convenience of conducting ultrasound examinations at the patient’s bedside, in remote areas, or during emergency situations, and wearable devices will become part of the ultrasound tool kit. Their affordability and ease of use make them accessible to a broader range of healthcare providers, expanding the potential applications of ultrasound. I predict that, under a doctor’s care and orders, the ways in which ultrasound is used will expand!

2. Artificial Intelligence (AI) Integration

AI is revolutionizing the field of medical imaging, and ultrasound is no exception; however, sonographers and doctors are not going anywhere. AI algorithms can assist in image analysis, automate measurements, enhance quantitative imaging, and aid in the detection of abnormalities. In the near future, we can anticipate more sophisticated AI integration into ultrasound systems, which will not only enhance diagnostic accuracy but also improve workflow efficiency. AI will play a significant role in making ultrasound more accessible and reliable in terms of scanning, reading images, and delivering accurate results.

3. 3D and 4D Imaging

Three-dimensional (3D) and real-time 3D (4D) ultrasound imaging will continue to advance, providing clinicians with more detailed and interactive views of anatomical structures. This trend will be particularly valuable in obstetrics for capturing fetal development and in various other medical specialties where enhanced visualization and quantification are crucial. Expect to see more applications for complex anatomical assessments and dynamic studies.

4. Point-of-Care Ultrasound (POCUS)

Point-of-care ultrasound, or POCUS, is transforming the way medical professionals diagnose and manage patients. POCUS is expected to see increased adoption in various clinical settings, including emergency medicine, anesthesiology, primary care, and critical care. As training programs expand, more healthcare providers will be equipped to use POCUS for rapid and accurate assessments, which can lead to improved patient care and outcomes on the spot. With increased adoption, interest in ultrasound practice accreditation in this area is rising.

5. Therapeutic Ultrasound Applications

Beyond its diagnostic role, ultrasound is making great advances in therapeutic applications. Techniques like High-Intensity Focused Ultrasound (HIFU) are being employed for noninvasive surgeries, cancer treatments, and targeted drug delivery. In the coming years, we can expect to see further developments in therapeutic ultrasound, offering less invasive treatment options for a wide range of medical conditions and increasing the potential for ultrasound theranostics.

The future of ultrasound is incredibly promising with these 5 trends at the forefront of its evolution. From portable devices and AI integration to advanced imaging techniques and expanding applications in point-of-care and therapeutics, ultrasound is set to become even more integral to modern healthcare. Stay tuned as these trends continue to shape the landscape of medical imaging and patient care. We’re excited to witness the many possibilities that lie ahead for this versatile technology.

Therese Cooper, BS, RDMS, is a sonographer and the Director of Accreditation at the American Institute of Ultrasound in Medicine.

Time to Pause and Reflect

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During my early career as an Urgent Care Physician, I worked in busy, under-served, and rural Urgent Care Centers (UCCs). At that time, Point-of-Care Ultrasound (POCUS) was not popular. I practiced in high acuity UC settings, where we would often have US machine and US tech during business hours with an on-call tech after hours, as well as CT scan, STAT labs, and IV placement capabilities. However, I was interested in learning more about POCUS – so I attended a few CME courses that taught MSK and soft tissue, led by companies like Sonosite.

After these courses, I returned to work excited and attempted to convince my medical director to incorporate POCUS into our UC workflow. My idea was rejected. As time passed and I moved to other jobs, I would again ask at each new urgent care clinic and would be met with the same response. They claimed it is cost-prohibitive and that training providers would be cumbersome.

The basic skills I learned from these courses withered away from lack of practice shortly after finishing these 2-day seminars. Years passed by, and I forgot about POCUS, having felt discouraged following many unsuccessful attempts to integrate it into my practice.

Yet, over the past 5 years, I have noticed a shift in the operation of UCCs nationwide. There has been a tendency to eliminate US and CT from UC, reserving it for emergency department (ED) patients and scheduled outpatient orders. Our UCC still maintained STAT labs and IV placement capabilities, but this shift created bigger problems. Mainly, it led to increases in unnecessary ED transfers, which led to longer ED wait times, unsatisfied patients, more UC bounce-backs, and delayed patient care. At the same time, the shortage of primary care providers (PCPs) continued to grow, and the wait to get timely appointments with their PCP remained difficult, resulting in many patients not receiving the care they needed.

When I first started practicing UC Medicine, the goal of many UCCs was to reduce ED burden through managing stable patients while at the same time reducing primary care burnout by offering primary care services to bridge the gap in access to care. Nonetheless, the lack of imaging in the UCCs has caused the urgent care world to fall short of these goals – including duplicate and incomplete workups and increased costs to patients (particularly when labs are ordered only to discover the need to go to the ED to finish the workup). Add on top of this the fact that many insurance companies will not pay for 2 visits on the same day and the lack of consistent X-ray staffing due to shortages, and it becomes clear that there is a dire need for POCUS and POCUS-trained providers in our UCCs.

Two years ago, I decided to dedicate my time to learning and practicing POCUS. Recently, I decided to do a fellowship in POCUS. I wanted to refine my skills to provide the best care for my patients. Many patients come in with presentations such as undifferentiated dyspnea. Is it CHF? Pneumonia? COPD? POCUS can help with medical decision-making and finalize safe disposition to the ED or home.

What about that popliteal DVT that you strongly suspect on your shift? It is 7:00 pm on a Friday night, and outpatient imaging will not be able to get your patient in until the following week. How would you handle this situation? Unfortunately, many times patients must go to the ED and sit for many hours to get a DVT study done. Or what about the early-pregnancy patient that comes in with some vaginal bleeding and pelvic pain? Is it an intrauterine pregnancy (IUP) or a miscarriage?

POCUS helps you treat each of these patients with clinical accuracy and speed. For example, one day in our clinic, we had no x-ray tech on shift. I didn’t want to ask the patient to travel, as they, like many in our patient population, have difficulty finding affordable and timely transport. Instead, I was able to diagnose a fracture and treat it using my hand-held ultrasound.

Another time, I was able to diagnose a shoulder dislocation and do postreduction imaging to confirm placement. I’ve been able to rule out cardiac tamponade on a young patient with chest pain and pericarditis on EKG and send him home safely. POCUS enabled me to see a foreign body inside an abscess I would have missed. The list of what POCUS has enabled me to diagnose and treat goes on: a right lower quadrant mass on a patient with suspected appendicitis, with expedited care as the ED saw these images and took him straight to CT scan; several Pneumonias on the ultrasound that were missed on chest x-ray; the ability to differentiate between biliary colic and acute cholecystitis while doing a right upper quadrant scan.

One day, a colleague came and asked me if I could do a Renal Ultrasound on her patient, an elderly female who had been seen in the ED the day before with flank pain and hematuria. She received a CT scan in the ED showing moderate hydronephrosis and a partially obstructed ureteric stone. She came to the UC 24 hours later with worsening flank pain and vomiting. My bedside POCUS showed severe hydronephrosis and a completely obstructed ureteric calculus, with the added advantage of ruling out abdominal aortic aneurysm (AAA) at the same time. We were able to transfer her to the ED and expedite her care.

I offer all of these examples to showcase POCUS’s diverse breadth and depth in urgent care medicine. Undoubtedly, it saves lives, improves patient outcomes, and reduces costs. It is time to take a step back and consider the long-term benefits of POCUS.

The money spent now on machines and training will pay dividends in the future. While it seems like a longer-term investment, it will be recouped quickly, and the benefits will continue year after year.

Amera Gaballa, MD, is an Advanced Primary Care Ultrasound Fellow at the University of Michigan in Ann Arbor.

Ultrasound in the Diagnosis and Management of Chronic Obstructive Pulmonary Disease

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Chronic Obstructive Pulmonary Disease (COPD) is a prevalent and debilitating respiratory condition that affects millions of people worldwide. While traditional diagnostic methods like spirometry and imaging techniques such as CT scans have played a vital role in managing this disease, ultrasound is emerging as a powerful tool in both diagnosis and treatment.

The Basics of COPD

COPD is a progressive lung disease characterized by the restriction of airflow due to chronic bronchitis and emphysema. The primary symptoms include breathlessness, coughing, and excessive mucus production. It is typically associated with a history of smoking, but environmental factors also play a role. Diagnosing and monitoring the progression of COPD is crucial for effective management.

The Role of Ultrasound in Diagnosis

Sonographic Assessment of Lung Morphology: Ultrasound imaging offers a noninvasive and radiation-free approach to assess lung morphology. Studies published in the Journal of Ultrasound in Medicine have demonstrated the effectiveness of ultrasound in evaluating lung parenchyma,1 pleura,1 and diaphragm.2 By examining these elements, clinicians can identify changes in the lung structure and rule out other conditions that might mimic COPD symptoms.

Evaluation of Diaphragm Function: COPD often affects diaphragm function, resulting in respiratory muscle weakness. Ultrasound allows for real-time assessment of diaphragm movement, enabling clinicians to detect early signs of diaphragmatic dysfunction.2 This information is valuable in selecting the appropriate treatment strategy for each patient.

Ultrasound-Guided Thoracentesis

In some cases, COPD patients develop pleural effusion, a condition characterized by an abnormal buildup of fluid in the pleural cavity. Ultrasound can be used to guide thoracentesis, a procedure in which this excess fluid is drained. A Journal of Ultrasound in Medicine report has highlighted the accuracy and safety of ultrasound guidance during this procedure, minimizing complications and improving patient outcomes.3

Monitoring Disease Progression

Ultrasound is not limited to the initial diagnosis but also plays a crucial role in monitoring COPD progression. Repeat ultrasound examinations can help evaluate changes in lung structure, assess diaphragm function, and track the effectiveness of ongoing treatments. Regular ultrasound monitoring can lead to more tailored and effective care plans for COPD patients.

Point-of-Care Ultrasound in COPD

Point-of-care ultrasound (POCUS) is a valuable tool for quickly assessing COPD exacerbations in emergency situations. It allows healthcare providers to rapidly evaluate lung abnormalities, pneumothorax, and pleural effusion, guiding immediate treatment decisions.4

Future Implications

As technology continues to advance, ultrasound is likely to play an even more prominent role in the diagnosis and management of COPD. Developments in portable and handheld ultrasound devices are making it easier for clinicians to perform ultrasound examinations at the bedside, providing real-time information to aid in decision-making.

Conclusion

The use of ultrasound in the diagnosis and management of COPD is a promising and evolving field. It offers a noninvasive, safe, and cost-effective means of assessing lung morphology, diaphragm function, and pleural effusion. With continued research and technological advancements, ultrasound is likely to become an indispensable tool in the fight against this chronic respiratory disease, helping patients receive more accurate diagnoses and tailored treatment plans.

References:

1. Martelius L, Heldt H, Lauerma K. B-lines on pediatric lung sonography: comparison with computed tomography. J Ultrasound Med 2016; 35:153–157. doi: 10.7863/ultra.15.01092.

2. Xu JH, Wu ZZ, Tao FY, et al. Ultrasound shear wave elastography for evaluation of diaphragm stiffness in patients with stable COPD: A pilot trial. J Ultrasound Med 2021; 40:2655–2663. doi: 10.1002/jum.15655.

3. Lane AB, Petteys S, Ginn M, Nations JA. Clinical importance of echogenic swirling pleural effusions. J Ultrasound Med 2016; 35:843–847. doi: 10.7863/ultra.15.05009.

4. Copcuoglu Z, Oruc OA. Diagnostic accuracy of optic nerve sheath diameter measured with ocular ultrasonography in acute attack of chronic obstructive pulmonary disease. J Ultrasound Med 2023; 42:989–995. doi: 10.1002/jum.16106.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Interested in learning more about lung ultrasound? Check out the following articles from the American Institute of Ultrasound in Medicine’s (AIUM’s) Journal of Ultrasound in Medicine (JUM). After logging into the AIUM, members of AIUM can access them for free. Join the AIUM today!

Join the POCUS Revolution: Unlock the Power of Point-of-Care Ultrasound

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A Hand-held ultrasound device scanning a patient

If you’re a fan of the AIUM (American Institute of Ultrasound in Medicine), then you already understand the importance of ultrasound technology in revolutionizing patient care. However, the emergence of Point-of-Care Ultrasound (POCUS) has taken this technology to new heights. POCUS is transforming the medical landscape, offering a sleek, affordable, and user-friendly solution that brings ultrasound imaging directly to the bedside. In this blog post, we’ll explore the advantages of POCUS over other imaging fields, share statistical data, discuss key POCUS techniques, and invite you to join us at the AIUM’s POCUS Course in Portland, Oregon, sponsored by AIUM and OHSU (Oregon Health & Science University), where you’ll discover the top 5 reasons to attend.

POCUS: Your Trusty Sidekick
POCUS is designed to be there for you when you need it the most, acting as a trusty sidekick to clinicians. With its ability to be performed at the bedside, POCUS delivers real-time answers, confirming diagnoses and guiding procedures without the need for additional appointments or waiting for results.

The Power of POCUS 

Let’s explore some statistical data that demonstrates the effectiveness and widespread adoption of POCUS:

  • Improved Diagnosis Accuracy
    According to a study published in a Royal College of Physicians journal, POCUS improved the accuracy of initial diagnoses compared to physical examination alone in various medical specialties, including emergency medicine, critical care, and primary care.
    Reduced Supplemental Exams
    A research article published in the Journal of Ultrasound in Medicine found that POCUS reduced the need for additional imaging studies and can reduce length of stay and imaging costs in various cases leading to significant cost savings and streamlined patient care pathways.
    Enhanced Patient Outcomes
    A systematic review and meta-analysis published in the Ultrasound Journal demonstrated that POCUS-guided interventions in cardiac patients resulted in improved outcomes, including reduced mortality rates and shorter hospital stays.

Key POCUS Techniques

POCUS encompasses various techniques that aid in diagnosing and guiding procedures. Some of the key techniques include:

  • Focused Cardiac Ultrasound (FOCUS)
    FOCUS allows clinicians to rapidly assess cardiac function, detect pericardial effusions, and evaluate for cardiac abnormalities such as wall motion abnormalities or valvular dysfunction.
  • Lung Ultrasound (LUS)
    LUS is valuable in the assessment of pulmonary conditions, including pneumothorax, pleural effusions, and pulmonary edema. It provides real-time visualization of lung sliding, B-lines, and consolidations.
  • Abdominal Ultrasound
    Abdominal POCUS aids in the evaluation of acute abdominal pain, gallbladder disease, kidney stones, and abdominal aortic aneurysms, among other conditions. It enables quick assessment and intervention in critical situations.
  • Musculoskeletal Ultrasound
    Musculoskeletal POCUS allows for an accurate evaluation of joint effusions, tendon injuries, muscle tears, and other soft tissue abnormalities. It assists in guiding interventions such as joint aspirations and injections.

POCUS is a game-changer, offering real-time answers that confirm diagnoses and guide procedures at the bedside. The statistical data highlights its effectiveness in improving diagnosis accuracy, reducing the need for supplemental exams, and enhancing patient outcomes. Don’t miss your chance to join the POCUS revolution and become a superhero in your own right. Register today for the AIUM’s POCUS Course in Portland, Oregon, and unlock the power of Point-of-Care Ultrasound. It’s time to level up your medical game and make a lasting impact on patient care. Sign up today!

Sources
Smallwood N, Dachsel M. Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine? Clin Med (Lond) 2018; 18(3):219–224. doi: 10.7861/clinmedicine.18-3-219. PMID: 29858431; PMCID: PMC6334078.

Amina Jaji, Rohit S. Loomba. Hocus POCUS! Parental quantification of left-ventricular ejection fraction using point of care ultrasound: Fiction or reality? [published online ahead of print December 30, 2022] Pediatr Cardiol. doi:10.1007/s00246-022-03090-w.

Kasmire KE and Davis J. Emergency department point-of-care ultrasonography can reduce length of stay in pediatric appendicitis: A retrospective review. J Ultrasound Med 2021; 40:2745–2750. https://doi.org/10.1002/jum.15675

Ávila-Reyes D, Acevedo-Cardona AO, Gómez-González JF, Echeverry-Piedrahita DR, Aguirre-Flórez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J 2021; 13(1):46. doi: 10.1186/s13089-021-00248-0. PMID: 34855015; PMCID: PMC8639882.

Arian Tyler, BS, is the Digital Media and Communications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

Threading the Needle at UltraCon

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Ultrasound has many advantages when used for interventional procedures such as improved visualization of the anatomy in relation to the needle tip. But acquiring the skills to perform ultrasound‐guided procedures takes time and practice.

And that is why the AIUM has devoted a full-day symposium called “Threading the Needle” to this topic on March 27, 2023, at UltraCon. The symposium provides a comprehensive overview of ultrasound-guided procedures, including:

Instrumentation
The needles and associated instrumentation commonly used in ultrasound-guided procedures will be shared. Important features and variations in equipment will be introduced for all specialties.

Teaching Tools
How do you teach others at your institution to perform procedures? The facilitator will provide an overview of best practices with specific examples.

Skills Station
Needle guidance principles will be taught for clinical applications such as IV access, target practice, and more utilizing hands-on models and cutting-edge technologies.

Safety
What are the important safety considerations when performing ultrasound-guided procedures?

Threading the Needle is just one of eight in-depth symposia featured at UltraCon 2023. Check out the Full Schedule to get a sneak peek at everything you could learn.

Another helpful resource about these procedures is the AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures.

Therese Copper, BS, RDMS, is the Director of Accreditation, and Mark Macoit is the Marketing Manager at the American Institute of Ultrasound in Medicine (AIUM).

Why Have UltraCon FOMO When You Can Be a Part of the Transformation of Medical Ultrasound?

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Are you still on the fence about deciding whether or not to attend UltraCon, a reimagined take on the American Institute of Ultrasound in Medicine’s annual meeting? The transformation of the AIUM’s annual ultrasound meeting into UltraCon is an exciting step forward for the field. It will provide a platform to connect professionals, share ideas, and learn from each other. 

Previously, we’ve highlighted the benefits of attending Day 1 and Day 2 of UltraCon, but what about Day 3? Just one look at the UltraCon schedule, and you can tell that this is going to be its busiest day yet! Despite the jam-packed program, there are a ton of amazing professional development opportunities ready for you to explore. On Tuesday, four new symposia will kick off, covering topics from 3D/4D imaging to musculoskeletal sonography. There’s also a shark tank competition, an e-poster kiosk hall, the annual AIUM Awards session, and don’t forget about the William J. Fry Memorial Lecture. 

Let’s dive into the first new symposia, Early Pregnancy Ultrasound: Implications and Impacts on Care. This TED-talk-style forum is a great resource for learning about critical issues in the first trimester, such as providing equitable care in the emergency department and managing life-threatening situations. It has not only valuable information for medical professionals but also provides important insight into how to support patients after Dobbs. Participants can earn up to 1.5 CMEs.

Next, we have Optimizing Outcomes in Prenatal Imaging. During this symposia, participants can increase the quality and patient experience in obstetric imaging with a multidisciplinary approach. A group of specialists will present TED talks on topics such as early trimester issues, health inequities, and maternal/fetal life-threatening situations. Improve imaging outcomes via a perception bias workshop, challenging cases, and using the 3D world to understand ultrasound. Plus, roundtables with industry on image optimization and a special session on understanding the lifecycle of prenatal imaging. Participants can earn up to 3.0 CMEs.

POCUS: Cutting-Edge Uses and Controversies is the third symposium of Day 3. Point-of-care ultrasound (POCUS) is revolutionizing the way clinicians diagnose and treat patients. By providing real-time insights, POCUS offers quick, accurate, and cost-effective diagnosis of clinical problems. From development to bedside, POCUS has changed the game for clinicians worldwide. Are you seeking an engaging and informative symposium to discuss current POCUS advancements in medical ultrasound? Look no further than POCUS: Cutting-Edge Uses and Controversies symposium, which discusses topics such as global health, first-trimester concerns, scan ownership, POCUS workflow, and more. With an array of activities, including lectures, panel discussions, and workshops, this is sure to be a stimulating symposium that will leave you informed and inspired.

Breaking the Sound Barrier: Shaping the Future of Ultrasound is the last symposium of the day. The highly interactive symposium on ultrasound technologies is a great opportunity for clinicians, technologists, researchers, industry, and other stakeholders to learn about the latest advancements in ultrasound technology. This symposium will provide an invaluable platform for experts to share their knowledge and insights on how to utilize ultrasound techniques in clinical settings effectively. Attendees will have a chance to interact with leading professionals from around the world and discuss potential solutions for existing challenges within this field.

Outside of attending the symposia, there are several other interactive activities for participants to engage in. Firstly, the AIUM supports an ePoster program every year where attendees can explore and learn at their own pace through self-guided exploration. Secondly, attendees who have a great ultrasound idea and want to pitch it to industry can submit an application to pitch their ideas to venture capitalists, leaders from the industry, and an IP attorney, for the chance to win a cash prize of $1,000. Lastly, don’t forget to attend the 2023 William J. Fry Lecture given by pioneer in gynecologic ultrasound, Dr. Steven R. Goldstein, entitled “Do You Do POCUS: Why reinvent the wheel?”.  

UltraCon will be the must-attend event of the year for medical professionals who want to stay up-to-date on the latest advancements in ultrasound technology. With a wide variety of engaging sessions and workshops, there’s something for everyone, so avoid getting caught with FOMO. All of this is just what is available on the third day of symposia at UltraCon. Check out the Full Schedule to start planning out your UltraCon journey.

Arian Tyler, BS, is the Digital Media and Communications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).

What if Ultraportable Ultrasound Devices Were the Future of Healthcare in Africa?

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The improvement and miniaturization of ultrasound devices is a result of the need to make ultrasound devices quickly accessible regardless of location. The right diagnosis at the right time in the right place can take you a step ahead in this race for point-of-care diagnosis.

Developed countries have experienced very significant direct and indirect impacts on the quality of care for patients in acute care and those who are hospitalized. However, if in these countries, ultrasound has made it possible to bypass certain additional examinations (standard radiography, CT, MRI, etc) for certain precise indications despite the latter being nevertheless available, it can be deduced logically that under certain conditions, point-of-care ultrasound (POCUS) would have an even greater impact in settings where other modalities are simply not available.

Indeed, developing countries and areas with limited resources often have in common a lack of diagnostic imaging means: old, non-mobile X-ray machines with little or no function at all and you’ll rarely find CT or MRI, and when you do, it is inefficient except in concentrated, large cities.

Add to this an extremely limited electricity supply, which significantly reduces the effectiveness of the existing means even further. It directly results in the impossibility of full-time operation due to power cuts, and indirectly through breakdowns and the gradual deterioration of the equipment related to variations in electrical voltage.

These various problems make Africa extremely fertile ground for the use of clinical ultrasound (POCUS) with exactly the same benefits as those obtained in other better-developed regions, but better still the absence of other means of diagnosis, which could lead clinical ultrasound to become the “gold standard” for clinical diagnosis in African.

The problem, however, is the availability of the devices, especially the type of device. Indeed, the devices currently present in Africa are either static or relatively portable (more than 10kg), which poses a real problem of mobility for an imaging modality that could otherwise be performed at the patient’s bedside.

Ultraportable devices with their small size, their resistance, their autonomy, and their low energy requirement could be a valuable diagnostic aid in Africa. However, there remains the problem of their availability (most manufacturers limit their network to developed countries) and their cost (due to the low purchasing power of practitioners in developing countries), the very idea of ​​obtaining one at its actual cost is completely illusory.

What if the manufacturers of ultraportables developed strategies to support doctors who want to equip themselves and the educated societies with POCUS, set up conventional classroom-based training courses and E-learning free or at a reduced price for all doctors wishing to learn?

Yannick Ndefo, MD, is a general practitioner in Cameroon and a POCUS ambassador for POCUS Certification Academy.

Interested in learning more about ultrasound in global health? Check out these posts from the Scan:

        Where it Matters Most

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        The infant, carried by her father, had been vomiting for several days. The patient’s history was consistent with pyloric stenosis, but there were still other differential diagnoses to consider. The surgeon caring for the patient was trained in Morocco and France. He was an excellent physician who returned to his community in the small coastal country of The Gambia in West Africa. The physician needed diagnostic ultrasound to confirm or refute the presumed diagnosis. He was plagued by indecision at the prospect of performing unnecessary surgery on the infant. The patient had traveled at great cost and distance to arrive at the only tertiary care center in the country. Her family needed help and if they could not find it here, they were out of options.

        At the invitation of the surgeon, I was taking the entire attending physician group from every specialty available through a point-of-care ultrasound (POCUS) course. The course was tailor-made for surgeons, despite having representatives present from internal medicine and pediatrics. It was reasoned that the largest immediate gains would be from trauma care, ultrasound-guided procedures, and confirmation of surgical diagnoses and complications. The amount of blunt trauma and blind procedures including liver biopsies was staggering.

        Each day focused on problem-based and group learning, with gamification and competition built it. The goal was to keep the learners engaged and follow up with deliberate practice every afternoon. The surgeon would bring patients from the hospital who required diagnostics, which were unavailable until now. Patients made the trek up 2 flights of stairs, where we were teaching in the only air-conditioned space. Conditions that would be identified early in high-resource regions are often elusive without the necessary diagnostics. With POCUS, we identified patients with heart failure, pneumonia, bowel obstructions, appendicitis, and complications of pregnancy. We also identified conditions that are less readily seen in high-resource health systems such as rheumatic heart disease and hepatic abscesses.

        Each day focused on problem-based and group learning, with gamification and competition built it. The goal was to keep the learners engaged and follow up with deliberate practice every afternoon. The surgeon would bring patients from the hospital who required diagnostics, which were unavailable until now. Patients made the trek up 2 flights of stairs, where we were teaching in the only air-conditioned space. Conditions that would be identified early in high-resource regions are often elusive without the necessary diagnostics. With POCUS, we identified patients with heart failure, pneumonia, bowel obstructions, appendicitis, and complications of pregnancy. We also identified conditions that are less readily seen in high-resource health systems such as rheumatic heart disease and hepatic abscesses.

        The surgeon confirmed the diagnosis of pyloric stenosis during our POCUS course. He took his patient to the operating theater with confidence and she did well postoperatively. Ultrasound continues to make a lasting impact in The Gambia. Together, we are building a sustainable program that will incorporate POCUS into all graduate medical education. POCUS impacts care wherever it is used by trained professionals, but in my experience, it is the single most important diagnostic tool in low-resource health systems.

        Michael Schick, DO, MA, MIH, FACEP, is an Assistant Professor of Emergency Medicine and Director of International Ultrasound at UC Davis Medical Center.

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