Monday, January 30, 2012

Learning to Perform Ultrasound Exams

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.

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!