Teaching Using Portable Ultrasound
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Teaching Using Portable Ultrasound

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Teaching Using Portable Ultrasound Teaching Using Portable Ultrasound Presentation Transcript

  • Teaching Using Portable Ultrasound Richard Usatine, MD Bill Rodney, MD
  • Objectives
    • Describe the value of ultrasound technology in family medicine clerkship learning experiences.
    • Discuss the methodology to incorporate portable ultrasound into family medicine clerkship teaching.
    • List the resources available to learn and teach ultrasound within the settings and scope of a procedurally enhanced family physician.
  • Procedurally Enhanced Family Physician
    • May use ultrasound in
      • the office
      • labor and delivery
      • emergency department
      • acute care clinics
      • International missions
      • others
  • Future of Family Medicine
    • Embrace technology in your practice
    • Enlarge the basket of services
    • Ultrasound can enhance your practice and can be an exciting skill to teach students
    • STFM task force just recommended ultrasound as an essential skill for FM residents
  • Leaders in ultrasound in family medicine
    • Ric Hahn, MD
    • Bill Rodney, MD
    • Mark Deutchman has created wonderful interactive CD-ROMs on
      • OB ultrasound
      • abdominal ultrasound
      • emergency medicine.
      • [email_address]
  • Portable ultrasound
    • Units can be purchased from $7,000 -$35,000
    • $12,000 can do it for a new machine
    • $7,000 for a used machine
    • Ultrasound transducers can be plugged into laptop computers
    • Demonstrations to follow
  • Grant funding
    • Allowed UTHSCSA to purchase 3 portable ultrasound units
    • Part of a visualization and simulation Grant funded by AT&T
    • The Paradox of Misaligned Incentives
        • University of Tennessee; disallowed by faculty group, purchased with discretionary funds but created revenue
        • Meharry- same; published data $
        • Medicos—self funding; same+
  •  
  • Clerkship curriculum
    • 90 minute hands-on workshop using portable ultrasounds
    • A pregnant volunteer is recruited
    • Often it is a pregnant student from within the group or a fourth-year student
    • Students practice on each other
  • Ultrasound basics
    • Explain the use of sound and how sound is transmitted differently in liquids versus solids
    • White shows reflection and dark shows transmission
    • Shadowing occurs when in the bones or stones reflect the sound back to the transducer
  • Transducers
    • Curvilinear or linear
    • Fixed frequencies
    • Variable frequencies are newer
    • Image tweaking transcends physics
      • Contrast and brightness
    • Depth of scan can be adjusted
    • Increasing gain increases the white in the picture
  • Start with Fetal ultrasound Demo
    • Students enjoy seeing the moving fetus and identifying the body parts
    • Fetal heart motion is easy to see and heart anatomy can be visualized
    • Pregnancy dating can be demonstrated by showing how measurements are taken of biparietal diameter, head circumference, abdominal circumference, and femur length
    • Maternal gallbladder easy to see without fasting
  • Abdominal ultrasound
    • Demonstrate the gallbladder in the pregnant woman and look for stones
    • A new student volunteers for a view of the nonpregnant abdomen
    • The liver and diaphragm are demonstrated
    • The diaphragm is easy to see when the subject takes in a deep breath and holds it
    • The use of controlled breath-holding is demonstrated
  • Abdominal ultrasound continued
    • The right kidney is visualized using the liver as an ultrasound window
    • The abdominal aorta is demonstrated in a sagittal and transverse plane
    • The abdominal aortic diameter is measured easily
    • Don’ t waste time with more difficult organs - pancreas
  • Thyroid ultrasound
    • The higher frequency linear transducer is connected
    • The new volunteer has the neck scanned to see the thyroid gland, the trachea, and the carotid arteries
    • It is easy to identify the thyroid gland on both sides of the trachea
    • Look for thyroid nodules and cysts
  • Musculoskeletal ultrasound
    • The linear transducer can be used to look at the structures of the shoulder and the rotator cuff
    • Emerging area with no published studies
  • TransA Pelvic ultrasound
    • Occasionally the curvilinear probe for the abdominal ultrasound can be used to look at the uterus and ovaries in a willing volunteer
    • A volunteer can remain fully clothed but the transducer must point downward toward the pelvic structures
    • Main problem is jelly on the clothing which can be washed off
  • Practice time
    • To massage tables are set up each with a portable ultrasound machine
    • Ultrasound gel or K-Y gel are used to help transmit this sound at the transducer skin interface
    • Plenty of tissues, paper towels or cloths need to be available to clean the gel up afterwards
    • These materials are also used to keep the gel off of clothing
  • Student participation
    • Students jump in and start using the ultrasounds on each other immediately
    • There always many volunteers willing to lift up their shirts and show their abdomens
    • The students enjoy holding the transducers at looking for the structures
    • Belly button rings do not get in the way
    • Adiposity is the enemy of ultrasound
  • Student surprises
    • Some students will reveal a new pregnancy
    • One student showed us her single abdominal kidney
    • The heart could be visualized in some students with the curvilinear transducer
  • Student feedback
    • For many students it is the first time that they have had a chance to see or practice ultrasound
    • Students are intrigued to know that family doctors can do this type of work
    • Anatomy is reinforced and comes to life outside of the O. R. or the gross anatomy lab
  • Portable ultrasound in community outreach
    • Portable ultrasound machines are used in the student-run clinics
    • In one free clinic there are women in a residential drug rehabilitation program
    • Ultrasound is used to show the women in their developing babies to help them connect with the reality of pregnancy
    • Hoping to encourage them to stay sober and drug-free
  • Future Directions
    • Encourage Family Medicine educators to incorporate ultrasound into their essential basket of clinical skills
    • Follow standardized clinical formats as available on www.psot.com
    • Computer assisted technologies are increasingly user friendly and diagnostically precise
    • Elvis Winternational Ultrasound Courses available 2007-2011. [email_address]
    • Others
    • PRACTICE TIME
  • FM References
    • Dresang LT, Rodney WM, Rodney KM. Prenatal ultrasound: a tale of two cities. J Natl Med Assoc. 2006 Feb;98(2):167-71.
    • Dresang LT, Rodney WM, Dees J. Teaching prenatal ultrasound to family medicine residents. Fam Med. 2004 Feb;36(2):98-107.
    • Rodney WM, Deutchman ME, Hartman KJ, Hahn RG. Obstetric ultrasound by family physicians. J Fam Pract 1992;34:186-94, 197-200.
    • Hahn RG, Davies TC, Rodney WM. Diagnostic ultrasound in general practice. Fam Pract 1988:5(2):129-35.
  • Portable Ultrasounds
    • Terason http:// www.terason.com /
    • Sonosite has a selection of hand-carried ultrasound units. http:// sonosite.com /
    • A less expensive portable MySono 201 ultrasound can be purchased at http://www.medison.com/eng/pd/bw/mysono201/more.asp
  • live demonstrations
    • Bill’s machine