My name is Dr. Craig McInnis. I am a veterinary small animal practitioner, like you. I just returned from NAVC in Florida. Many people dropped by our booth with questions about ultrasound: training, learning curve, ultrasound machines etc. Obviously learning and applying ultrasound in a general practice setting is increasing. I've decided to start this blog to help field questions about learning ultrasound.
LEARNING ULTRASOUND
As a veterinary general practitioner, you read radiographs, but
you are not a radiologist. The same will
be true of the ultrasound skills you develop.
You will do ultrasound to find lesions obvious to you. After your ultrasound exam, if you feel you
did not find the cause of the patient’s symptoms, you can consult with or refer
to a more experienced sonographer. This
is the same thing you do with radiographs, surgeries, or internal medicine
cases when you feel the patient needs more expertise than you have.
We DO NOT follow the traditional method of ultrasound
training. We have developed NEW and MUCH
MORE EFFECTIVE methods of training that WILL help you learn much faster than I
did.
A good beginning ultrasound training program should address
three major areas
a.
It should
teach the basic concept of using the transducer to move the ultrasound beam
around the abdomen or the structures of the heart. This is a process of developing manual skills
to manipulate the transducer and visual skills of reading the ultrasound screen.
b.
It should teach you to use the functions and
controls of the ultrasound machine you will be using in your practice. Every manufacturer uses different buttons,
knobs, or toggles to control the qualities of the ultrasound beam and the image
on the ultrasound screen. You need to
know how to establish a patient record, adjust depth, gain, and frequency, use
cinematic loop, make measurements, and save and retrieve images. Using all of the functions of your own ultrasound
machine needs to become second nature; something you do not have to think about
or search for.
c.
It should teach a method of systematically
finding and examining the organs of the abdomen or the structures of the heart.
Our intensive on site ultrasound training programs addresses
all of these areas. Even so, no one can
remember everything from a training program.
For the abdomen, we have developed the Tips & Techniques and General
Abdominal Scan DVDs to help you learn abdominal ultrasound. You can review the DVDs as often as you
need. For the heart, we have developed
the General Cardiac Exam. The DVDs can
also be used alone as a SELF STUDY training program.
After learning the basic skills, you need to practice your
skills A LOT. Ideally, YOU should
PERFORM ultrasound examinations under the supervision of an experienced
sonographer for about 3-6 months. This
does not mean that you WATCH SOMEONE ELSE do exams. YOU MUST PERFORM THE EXAMS. This is when you practice and learn to
recognize abnormalities. Most of us can
not afford the time or money to study and train in this way.
As an alternative, we have developed a series of DVDs to
help you learn as much as possible on your own.
The individual organ DVDs help you learn to recognize abnormalities.
Watching DVDs is not enough.
You must still practice your skills A LOT. In the early stages of learning, most people
feel that they are not competent enough to charge for their ultrasound
skills. This feeling is very common but
counterproductive. If you do not charge
something, in your own mind, your services are worthless. In the long run, you will not waste your time
doing something that is worthless.
It is much more productive to charge a lesser fee to help
cover the cost of your time and your ultrasound machine. I suggest calling your exam a FAST exam or an
abdominal screen. You should only offer
to screen the abdomen for something that YOU will recognize, like free fluid or
obvious masses. For example, if a
patient is presented for hematuria, you would be looking for signs of stones,
infection, or a tumor in the kidneys or urinary bladder. You will be providing a service for the
patient and for the owner. You will be
gaining experience. If you are not
satisfied with your own results, you can refer to or consult with a specialist,
just as you do now. As you improve your
own capabilities and experience, your fee can be increased.
Even when you have experience and confidence, you will have
clients who refuse a referral to a specialist or refuse to allow you to do a
complete abdominal or cardiac scan.
Consider offering a targeted exam for a lesser fee. If liver values are elevated, limit your
ultrasound exam to the liver and gallbladder.
If urinary signs are present, limit your exam to the kidneys and urinary
bladder. This strategy will give another
option to your client while making it possible for you to practice your skills
and increase your income. Both you and
your client must realize that a targeted exam will miss lesions in other
organs.
New discoveries continue to be made as technology
advances. Information we believe to be
true today is often proven to be false tomorrow. You should continue to supplement your
studies with ultrasound books for your reference library and continuing
education lectures. The study and application of ultrasound in your OWN
practice will make YOU a BETTER VETERINARY PRACTITIONER. Let’s get started!
