Thoracic Ultrasonography: Response

Abstract

We thank Drs Kastelik and Arnold for their interest in our recent article in CHEST.1Koenig SJ Narasimhan M Mayo PH Thoracic ultrasonography for the pulmonary specialist.Chest. 2011; 140: 1332-1341Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar They highlight a common and frequently discussed problem in medicine: competence and quality assurance. We agree that although a competency statement outlines what constitutes an acceptable thoracic ultrasound examination, it does not ensure adequate training on an individual basis, nor does it provide the means for ongoing quality assurance. Our fellows gain competence through experiential training and regular oversight by pulmonary/critical care attending physicians experienced in thoracic ultrasonography, but this may reflect local expertise and not general practice. The challenge remains to train pulmonary and critical care specialists in the important skill of thoracic ultrasonography.1Koenig SJ Narasimhan M Mayo PH Thoracic ultrasonography for the pulmonary specialist.Chest. 2011; 140: 1332-1341Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar The American College of Chest Physicians (ACCP) has taken concrete steps to provide training in thoracic ultrasonography in the United States. Training in thoracic ultrasonography is a key component in the numerous courses that the college has given to >2,000 clinicians over the past 7 years. The ACCP has developed a comprehensive critical care ultrasonography training program that includes lung and pleural ultrasonography. This Certificate of Completion program requires 7 days of course work, a 20-h Internet training component, and a mandatory 250 image portfolio collection, followed by a hands-on and image-based examination that includes thoracic ultrasonography. The image portfolio, which is reviewed by the faculty, allows an experienced ultrasonographer to provide meaningful feedback to the learner, thereby increasing skill level. In addition to the national ACCP program, we have developed a local ultrasound training course for fellows. Each summer, 80 first-year pulmonary/critical care fellows from New York City receive an intensive 3-day course in general critical care ultrasonography, including thoracic ultrasonography. Standardized training early in fellowship training ensures that, moving forward, these fellows will disseminate this valuable skill. Finally, we could not agree more that point-of-care bedside thoracic ultrasonography performed by the treating pulmonologist must be integrated with the clinical history and physical examination. In this regard, thoracic ultrasonography is a powerful extension of the physical examination, providing immediate diagnostic and therapeutic benefit. Thoracic UltrasonographyCHESTVol. 141Issue 5PreviewWe have read with great interest the article by Koenig and colleagues1 in CHEST (November 2011), in which the authors describe in a very enthusiastic and detailed manner the current understanding and the clinical use of thoracic ultrasonography by pulmonary specialists. In our institution, pulmonary specialists have been performing thoracic ultrasonography for a number of years, using a portable ultrasound machine to perform a large number of bedside thoracic ultrasonography procedures in respiratory outpatient clinic settings as well as for patients who are hospitalized. Full-Text PDF