A Loss of Great Magnitude

Good-bye, Harvey Leonard Nisenbaum, MD

Head shot of Harvey Leonard Nisenbaum, MD, FACR, FAIUM, FSRU.

We have lost a leading expert in ultrasound education, AIUM Past President, Harvey Leonard Nisenbaum, MD, FACR, FAIUM, FSRU, who died on October 8, 2020.

Dr Nisenbaum was a leader in the field of ultrasound even just out of school, when, after completing his residency in diagnostic radiology at Montefiore Medical Center in the Bronx, New York, he became a lieutenant commander in the U.S. Navy and served as the director of ultrasound at the former Naval Regional Medical Center in Philadelphia until 1976. That is when he joined the faculty of Albert Einstein Medical Center in Philadelphia, where he became the head of the Ultrasound section, acting chairman of Einstein’s Department of Radiology, and president of the medical center’s staff.

Dr Nisenbaum couldn’t help but share what he knew to encourage the next generation of ultrasound advocates. And, in 1993, enabling him to connect with more students, he moved on to the Department of Radiology at the University of Pennsylvania Perelman School of Medicine and, ultimately, chairman of the Department of Medical Imaging at Penn Presbyterian Medical Center (PPMC) from 2001 to 2018 and Emeritus Associate Professor CE of Radiology.

“Under his leadership, the Department introduced tremendous scientific advances in Medical Imaging into clinical practice and greatly expanded its contribution to the hospital’s mission.”

— Penn Presbyterian Medical Center

To honor his legacy, they will award the Harvey Nisenbaum Award for Medical Imaging Research at PPMC for the first time in 2021, which Dr Nisenbaum learned of before his passing. The award will recognize medical students, residents, and fellows who continue his legacy at the Department of Medical Imaging by creating new scientific intelligence through research. He had also earned a Special Dean’s Award for his help in developing and implementing the ultrasound curriculum for the Perelman School of Medicine.

Dr Nisenbaum was an active volunteer, he served on numerous committees, both at his hospital and for the many societies and organizations to which he was a member, including the American Institute of Ultrasound in Medicine (AIUM), which he joined in 1975. By 2009, he became President of the AIUM. During his tenure, donations to the Endowment for Education and Research to increased significantly, AIUM membership grew by 11%, and the online Career Center was launched as a new member benefit. Dr Nisenbaum was awarded the AIUM Presidential Recognition Award (twice; in 2006 and in 2012), and the Peter H. Arger, MD, Excellence in Medical Student Education Award (2020), which honors an individual whose outstanding contributions to the development of medical ultrasound education warrant special merit. Dr Nisenbaum earned this award for being instrumental in incorporating ultrasound into medical school curricula.

The Society of Ultrasound in Medical Education (SUSME), presented Dr Nisenbaum with the SUSME Legacy Award in 2013 for his outstanding contributions to ultrasound education. He served as president of the World Federation for Ultrasound in Medicine and Biology (WFUMB; 2015–2017), during which time 3 Centers of Education were created, in Paraguay, Moldova, and Sudan. Following his presidency, in 2018, he took a year-long sabbatical to volunteer even more of his time organizing projects to bring ultrasound to underserved countries.

In addition to these worldwide contributions, Dr Nisenbaum was also a past-president of the Pennsylvania Radiological Society, the Philadelphia Roentgen Ray Society, and the Greater Delaware Valley Ultrasound Society.

Dr Nisenbaum’s enthusiasm for ultrasound education along with his vast well of ultrasound knowledge and his willingness to share it have influenced countless students, physicians, and other medical professionals. He will be sorely missed.

Sonography and the Seeds of Education in Underserved Rural Clinics

How many of us began our sonography journey thinking about the number of callbacks that we would log per shift, the number of patients that we would scan in an 8-hour day, or, even worse, the number of career-ending ailments that we would amass? Zero; we didn’t. tammySterns_2017

We saw ultrasound as a way to contribute to something bigger than ourselves.

The complex, yet simplistic, science of sound drew us to the field. Looking at the screen and seeing the images come to life was fascinating, and being the first to see presenting pathology while shedding light on the diagnosis mesmerized us. The thought that even after 20 or 30 years in the profession we would encounter images of structures that we’d never seen before was enticing, and the opportunity to be a life-long leaner was thrilling.

Patient interaction and our role in their medical experience appealed to us. Not too much, not too little, but just the right amount of patient care time that allowed us to interact with them and leave a positive imprint on their journey. We imagined we would sit by their bedsides, walk them casually back to the exam rooms, and listen as they shared.

Our patients would come first.

Instead, too often, we found ourselves in the middle of a never-ending battle between cost-effectiveness and patient satisfaction reports. We logged more hours of callbacks than we ever thought possible, sometimes having difficulty even finding the correct key to open the ultrasound office door. We strived to create the profession that we had imagined within the confines of the variables that we’d been given. We did the best that we could, often to the detriment of our own bodies.

And, somewhere along the way, we forgot the wonder of our profession.

About 10 years ago, I had the opportunity to participate in my first overseas medical trip. A group of physicians and a few sonographers, with portable machines strapped in backpacks, were intent on sharing sonography with some of our peers an ocean away. It was during this trip that I saw the purest form of ultrasound come to life. We had one of the simplest of machines and the most basic of lectures and yet they came from miles to learn. The patients sat all day in the heat waiting for the opportunity to have an ultrasound scan. I witnessed ultrasound identifying and explaining pain that had existed for years. I saw tears of relief, joy, and despair as people received answers that changed their lives.

A few years later, I was able to return to the same place. I fully expected to find that they had not utilized our lessons on sonography to their fullest. Instead, our previous pupils greeted us with dog-eared textbooks, mastered skills, and the desire to know more! The seeds of education that we had planted had flourished as they realized the potential ultrasound held for their rural clinics. It offered the ability to quickly investigate and diagnose and you could see the wonder of ultrasound that we had once experienced reflected in their eyes.

Seven years ago, my family and I had the opportunity to move to a developing country. Living in the second-poorest country in the western hemisphere with limited medical availability, I now see every day the wonder of our profession come to life. All the benefits of ultrasound that we learned as students, that are often taken for granted, are the benefits that allow lives to be changed every day.

Portability – I can scan in a makeshift clinic, under a tree in a field, or in someone’s handmade shelter while they lay on the floor.

Inexpensive – Portable machines are relatively inexpensive and diagnostically sound, making them perfect for short-term trips or as gifts to native physicians.

Quick – Within minutes, we can scan and find answers to problems that have hindered the livelihood of those who are sick and in pain. One of my first patients was an OB patient who had been in labor for several days without any progress. A quick scan revealed placenta previa.

Relatively Safe – Without the worry of radiation and chemicals, ultrasound, when utilized by those who are qualified, provides a safe method of imaging.

True, my exam room isn’t exactly ergonomically correct and there are times that chickens and roosters run underfoot. I’ve had to prop the machine on a rock and scan in the brightest sun of the day. But I’ve also witnessed a mother’s face when she sees her baby for the very first time without me having to operate under the time constraints of efficiency. I’ve held a father’s hand as he realized that the pain he’s had for years isn’t the cancer he so greatly feared but a simple fix. I’ve scanned at the bedside of a daughter who lay dying without any medical options, and I fall more and more in love with our profession every single day.

Experience the wonder of ultrasound again.

If given the opportunity, I encourage you to participate in a medically related trip or volunteer opportunity. You will see firsthand how our profession and our images impact the world one life and one scan at a time. You don’t have to move permanently as we did to a developing country. Opportunities also abound in your local community from volunteering your time as a clinical instructor to scanning for local centers. Expand your horizons and allow yourself to experience the wonder of ultrasound again.

 

How have you seen ultrasound incorporated into medical care in other nations? Do you have an ultrasound story to tell? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

connect_now_live_digital_graphics_e-newsletter-1

Tammy Stearns, MS, RT(R), RDMS, RVT, FSDMS, is Director of Women’s Ministry and Sonographer for Project H.O.P.E. in Managua, Nicaragua. She is also the President of the Society of Diagnostic Medical Sonography and an adjunct professor of Diagnostic Medical Sonography at Adventist University in Orlando, Florida, and a sonographer consultant for Heartbeat International.  She is also the author of “Know Hope” and “Living Worthy”.

Flying Samaritans, the Seed to Pediatric Point-of-Care Ultrasound

There are some experiences in life that seem to have a tremendous impact on the person you become, and the career path you decide to take. When I started working with the Flying Samaritans in medical school, little did I know that it would change the trajectory of my career.

Kids from El Testerazo Mexico

The kids I fell in love with in El Testerazo, holding the pictures I had taken and shared with them. They came by even if they weren’t sick. Of note, they are now in their 20s with families of their own.

Since the UC Irvine School of Medicine was so close to the USA-Mexico border, the UC Irvine Flying Samaritans chapter was actually a driving chapter. Each month we drove down to El Testerazo, Mexico, to give medical care and medications to an underserved community. I immediately fell in love with the community and the children of El Testerazo, Mexico. They would all laugh at my then broken high school-level Spanish but would appreciate my trying. There was also something about the group of undergraduates (who ran the clinic), medical students, residents, and attending physicians who volunteered their time there that brought back the humanity to medicine. The experience was challenging and rewarding at the same time—to work with limited resources, but to become a trusted member of their community was priceless. Each time I went to the “Flying Sams” clinic, I remembered why I went into medicine in the first place.

During my time with the “Flying Sams,” I worked with a then Emergency Medicine resident, Chris Fox. When he told me he was going to Chicago to do a 1-year Emergency Ultrasound fellowship, I thought he was crazy.

Old ultrasound machine

The ancient beast of an ultrasound machine that we had in the “Flying Sams” clinic.

Not only was he leaving sunny Southern California, but he was going to spend a year looking at ultrasounds? When I looked at ultrasounds, I could barely make out structures; images looked like the old tube TVs from the 1980s. When Fox returned, he said, “Steph, the next big thing will be pediatric ultrasound.” Again, I thought he was crazy. But slowly, by seeing how ultrasound impacted the management of our patients in El Testerazo, I realized the brilliance in this craziness. Chris Fox’s enthusiasm and “sonoevangelism” was infectious. I think nearly everyone in the “Flying Sams” ended up eventually doing an ultrasound fellowship. Even though the ultrasound machine in the clinic was old, and images were of limited quality, we were still able to impact the medical care of this community that became near and dear to my heart.

And so it began…my passion for emergency ultrasound (now referred to as point-of-care ultrasound) and for Global Health. My initial goal was to become good at performing ultrasounds. As I quickly realized, I was one of the only people who had experience in pediatric point-of-care ultrasound. I felt a tremendous responsibility to become as knowledgeable and skilled as possible if I were going to teach others this powerful tool. After 4 years of undergraduate education, 4 years of medical school, 3 years of a Pediatrics residency, and 3 years of a Pediatric Emergency Medicine fellowship, I decided to do an additional 1-year fellowship in Emergency Ultrasound. With medical school loans looming and so many years without a “real job,” I was reluctant to do this. This California girl moved from sunny Southern California to Manhattan to embark on a 1-year Emergency Ultrasound fellowship. This was a move far outside of my comfort zone for so many reasons. And that was one of the reasons why it ended up being one of the best decisions I’ve ever made. It has been a privilege to be a part of this growing community… to take better care of the most vulnerable of patients… and to give this tool to other doctors around the world. I certainly would have never had these experiences or opportunities if it weren’t for the “Flying Sams” and Chris Fox; to both, I am forever grateful.

 Are you involved in global medical education? If so, what led to your decision to go into the field? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Stephanie J. Doniger, MD, RDMS, FAAP, FACEP is the Editor of the first pediatric point-of-care ultrasound textbook “Pediatric Emergency and Critical Care Ultrasound,” and is currently practicing Pediatric Emergency Medicine and Point-of-Care Ultrasound in New York. She has additional training in Tropical Medicine and is in charge of Pediatric POCUS education for WINFOCUS Latinamerica.

Who Runs the AIUM?

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?

Bagley_6Who 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.

Why I Volunteer for the AIUM

Bagley_6One of my favorite “demotivational” posters says:  “MEETINGS, none of us is dumb as all of us.” Except, in the case of working on an AIUM committee, that poster could not be further from the truth.

Not. Even. Close!

The opportunity to participate on an AIUM committee is both a privilege and a learning opportunity. I have so enjoyed the chance to serve on a committee, and would like to take this time to let you know what you can expect if you were to become a committee member.

The AIUM committees meet in person once a year at the Annual Convention, and then work by conference call and email during the rest of the year. Naturally, the biggest flurry of activity comes in the weeks preceding the Convention.

At that time, the committee chair or AIUM staff liaison will e-mail the minutes from the previous meeting to all the members. When the minutes arrive in our inbox, it is a reminder for us to check and see if we actually completed the assignments we were given at the last meeting!

Ideally, we would have completed them soon after the conclusion of the meeting, but hey, we are human! For many of us, the previous minutes are a reminder that we still have some work to do!

While we are working fast and furious to complete last year’s assignments, there is also a call for new business. When the liaison is notified of new business, he or she sends the information out to the members for review.

Aside from completing assigned tasks from the previous year, reading the new documentation prior to a committee meeting is probably the most important thing a committee member should do. In order to have meaningful discussion and/or resolution of the issues, the members must be informed and prepared to contribute to the conversation.

On the day of the meeting things run probably like all committees everywhere. We follow Robert’s Rules of Order when conducting business. (OK…only kind of-sort of—does anyone really know all of Robert’s rules?) The committee moves line by line on the agenda. Sometimes one topic may take 2 hours of conversation, and other times, we may move through the items much more expediently. All topics are important, and each gets the time and attention it deserves.

One thing that happens as we move through the agenda is, we ask each other to think about what the next steps might be. In some cases, people will volunteer to write something, look up old data, or reach out and solicit expert opinions from a field of study.

In some instances, some issues are too complex for the full committee to tackle them…a case of too many chefs spoil the soup. A subcommittee may be formed instead. Smaller groups are better suited to break the complex issue down into smaller parts, and then each person can work on a single task. When the work is complete, a more cohesive approach to the problem can be presented to the larger group.

Subcommittee work, like all committee work is voluntary. No one is expected to participate in every single facet of a committee, but in the spirit of shared governance, everyone should commit to serve in some manner.

And then you have the super committee members, who in spite of having a demanding career, they still manage to defy expectations and volunteer for everything and come through with outstanding levels of productivity! You have to realize they have superhero powers that most of us do not have, so you cannot compare yourself to them. If you can participate in a fair share of committee work, contribute your expertise, and be prepared for meetings, then you are exactly who an AIUM committee needs!

At the meeting’s conclusion, we all take our assignments for the next year, and ideally start working on them when we get home. This year the Bioeffects Committee has scheduled a mid-year conference call, and that will help those of us with assignments stay on task and pace our work. It will also be a nice time to catch up and converse with friends. Oh, I guess I forgot to mention, when you do committee work, you not only gain new colleagues, but also friends and even new mentors.

If you are interested in serving on a committee, my best recommendation is to match your talents and interests with a committee or a subcommittee that needs your expertise. That way, the work will seem more like fun, and the entire AIUM membership benefits from your contributions.

What have you learned from volunteering? What did you like or dislike? Would like to contribute to the AIUM? 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.