3 ru module 1 introduction presentation 09

Thomas Cook, MD, Program Director, Emergency MedicinePatrick Hunt, MD, Emergency Ultrasound Fellowship DirectorPalmetto Health RichlandColumbia, South Carolina

Clinical Ultrasound Course

3rd Rock Ultrasound – Module 1Slide 2

The indications & techniques presented in this cousre have been recommended in the medical literature and/or conform to the clincial practice of OUR faculty.

The equipment has not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques for which they are recommended. The package insert for the equipment should be consulted for use as recommended by the FDA.

Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques described are successfully used in our practice, they should be followed with discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances.

The equipment discussed in this course is shown solely for teaching purposes. Similar equipment from other manufacturers may produce similar clinical results to ours.


3rd Rock Ultrasound would like to give a special thanks to Dr. Joseph Woo for his permission to use the historical pictures of ultrasound systems in this presentation.

For more information about Dr. Woo’s work on the history of obstetrical ultrasound, please see the URL below.

http://www.ob-ultrasound.net/history1.html

http://www.ob-ultrasound.net/history1.html

MODULE 1 Introduction to Clinical Ultrasound

3rd Rock Ultrasound – Module 1

A Brief History of Ultrasound Why are we doing this? Program Goals Course Curriculum Post-Course Learning Opportunities

Slide 5

LECTURE OBJECTIVES

A Brief History of Ultrasound


“Discovery” in the 1820’s Industrial Use Military Use (SONAR) Medical use begins in1950’s

Slide 7

A BRIEF HISTORY OF ULTRASOUND

Origins of Ultrasound



Early Machines & Innovations



Early Ultrasound Images


1950’s - Radiology 1960’s – Cardiology 1970’s – Obstetrics & Gynecology

Slide 10


Early “Users”



EVERYTHING CHANGES



Computer Technology Explosion



Circuit Boards to ASICs



Smaller and Smaller



Nerd to Chic


Effect on Diagnostic Ultrasound• Created environment similar to personal

computers versus mainframes 25 years ago.

Slide 16


IT Computing Technology



Effects on Ultrasound Systems



Effects on Imaging

19701985

1990

1995

2000

2002

2005



EVERYTHING CHANGES(AGAIN)


VERY LARGE Infrastructure Requirements Necessitates Separate Departments (Radiology)

• Equipment• Space• Personnel

Slide 20


Comparison to Other Imaging

Nuclear CT-scanX-Ray MRI


ENORMOUS Data Management Requirements

Slide 21




Picture Archive Communication System


“PACS”

Slide 22





RELATIVELY small INFRASTRUCTURE Ubiquitous Presence at the Bedside

Limited Equipment Needs Small Space Requirement Small Data Loop Reduced Work Flow Needs

“PACS”

Slide 23





Effects on Ultrasound Labs


New Users of Ultrasound 1980’s and beyond

General Surgery & TraumaEmergency MedicineAnesthesiaCritical CareOrthopedicsEMS, USAR, Military, NASA

Slide 25


Ultrasound Uses in Medicine



Theoretical Considerations

CLINICAL Medicine Versus RADIOLOGY

Specific Indications & Goals

Why are we doing this?


COMPARISON OF EFFECTIVENESS OF HAND-CARRIED ULTRASOUND TO BEDSIDE CARDIOVASCULAR PHYSICAL EXAMINATIONKobal, S.L., et al, Am J Card 96(7):1002, October 1, 2005

METHODS: The authors, from Cedars-Sinai Medical Center and UCLA, compared the diagnostic accuracy of physical examination performed by one of five board-certified cardiologists, and use of a hand-carried ultrasound (HCU) device (OptiGo, Philips) by one of two first-year medical students in 61 patients with clinically significant cardiac disease. The students received 18 hours of training in use of the HCU device, which provides two-dimensional and conventional color- flow Doppler imaging, including four hours of lectures and 14 hours of practical experience. Expert echocardiography was the diagnostic gold standard.

RESULTS: Standard echocardiography identified 239 abnormalities in these patients (average, 3.9 per patient). Using the HCU, the students recognized 75% of these abnormalities compared with 49% identified by the cardiologists on physical examination (p<0.001). Corresponding specificities were 87% vs. 76% (p<0.001). The students were significantly more accurate than the cardiologists in the recognition of the most severe cases of left ventricular (LV) dysfunction and severe valvular disease (96% vs. 68%, p<0.001), and HCU exams by the students were also more accurate than physical exams by the cardiologists in the recognition of lesions that cause systolic or diastolic murmurs.

CONCLUSIONS: These findings reflect the inherent difficulties in evaluation of organ systems through percussion, palpation and auscultation, and the utility of technology developed to facilitate patient assessment at the bedside.

Slide 28

WHY ARE WE DOING THIS?

Can we do better?

. . . . (Hand-Carried Ultrasound) exams by the (medical) students were also more accurate than physical exams by the

cardiologists (without ultrasound) . . . .


Making Health Care Safer: A Critical Analysis of Patient Safety Practices

Agency for Healthcare Research & QualityU.S. Department of Health & Human ServicesShojania KG, et al. University of California at San Francisco / Stanford University

Slide 29


Why Do We Need Ultrasound for Vascular Access?


1) Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk;2) Use of perioperative beta-blockers in appropriate patients to prevent perioperative

morbidity and mortality;3) Use of maximum sterile barriers while placing central intravenous catheters to prevent

infections;4) Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative

infections;5) Asking that patients recall and restate what they have been told during the informed

consent process;6) Continuous aspiration of subglottic secretions (CASS) to prevent ventilator-associated

pneumonia;7) Use of pressure relieving bedding materials to prevent pressure ulcers;8) Use of real-time ultrasound guidance during central line insertion to prevent

complications;9) Patient self-management for warfarin (Coumadin™) to achieve appropriate outpatient

anticoagulation and prevent complications;10) Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition

in critically ill and surgical patients; and11) Use of antibiotic-impregnated central venous catheters to prevent catheter-related

infections.

Slide 30


Why Do We Need Ultrasound for Vascular Access?



Standard Imaging Paradigm



Standard Imaging Paradigm

What happens when they are not available?



New Paradigm

Program Goals


MISSION STATEMENTWe will empower clinicians with a comprehensive

curriculum to learn and integrate ultrasound technology into their patient management.

VISION STATEMENTDiagnostic ultrasound will become an integral component

of the training and practice of clinical medicine.

Slide 35

PROGRAM GOALS

Vision & Mission Statements


PROGRAM GOALS

Three Components of Skill Acquisition

Introductory Leaning

Practice-BasedLearning

Use in ClinicalDecision Making


PROGRAM GOALS






PROGRAM GOALS

EUC Offerings

Introduction to Emergency Ultrasound

Introduction to Trauma Ultrasound

Advanced Emergency Ultrasound

Introduction to Vascular Access

Introduction to Critical Care Ultrasound



PROGRAM GOALS




Course Curriculum


Ultrasound Physics & Principles Instrumentation and Scanning Techniques

Abdominal & Retroperitoneal Anatomy

Abdominal & Retroperitoneal Pathology

Ultrasound-Guided Vascular Access

Basic Cardiac Ultrasound

Female Pelvic Anatomy Gynecologic & Obstetric Pathology

Trauma Ultrasound Ultrasound Program Development

COURSE CURRICULUM

Course Modules


Cardiac Ultrasound

Live Lectures

Training Labs

Web-Based Educational Tools

Web-Based Testing

COURSE CURRICULUM

Modular Learning


Requires Subscription Fee

emergencyultrasound.com

Slide 44

POST-COURSE ACTIVITIES & LEARNING

On-Line Access to Course Lectures



On-Line Scan Review

Requires Separate Subscription Fee

EHealthConxHealthcare Connectivity Software and Services

TMEHealthConxHealthcare Connectivity Software and Services

TM


Physician performs exam Device “auto archives” directly

into credentialing system


Exam Review Portal

Final Thoughts


COURSE INTRODUCTION

Final Thoughts

A Historic Opportunity

A pivotal movement in the future of clinical medicine


ULTRASOUND-GUIDED PROCEDURES

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3 ru module 1 introduction presentation 09

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