Teaching Using Portable Ultrasound


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Teaching Using Portable Ultrasound

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