Teaching Using Portable Ultrasound

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

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

Teaching Using Portable Ultrasound

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