Novice Sonographers Research Articles

Intestinal Ultrasonography as an Alternative to Fecal Calprotectin to Monitor Patients with Crohn's Disease: Experience from a Novice Sonographer.

While fecal calprotectin (Fcal) is now recommended, the positioning of intestinal ultrasonography (IUS) is still unknown to monitor patients with CD. To assess the agreement between IUS performed by a novice sonographer and Fcal to detect active CD and to compare these two monitoring tools to determine the need for therapeutic escalation. In this cross-sectional prospective study, we consecutively included CD patients ≥ 18years-old with concomitant IUS and Fcal testing within 7days. IUS was performed by a novice sonographer. The endpoints were the agreement between IUS and Fcal (> 150µg/g) to detect active CD and the need for therapeutic escalation. Among 66 patients undergoing IUS, 56 patients had also Fcal testing. The agreement between IUS and Fcal to detect an active CD was 80.4% (κ-coefficient = 0.536 ± 0.127). Fcal, IUS or both had respectively the following positive (76.9%[54.0-99.8], 70.0%[49.9-90.1], and 81.8%[59.0-100.0]) and negative (81.4%[69.8-93.0], 88.9%[78.6-99.2], and 80.0%[68.3-91.7]) predictive values to detect active CD requiring therapeutic escalation. Using a 10 points-acceptability numerical scale, IUS presented with a better acceptability than Fcal (9.5 ± 1.2 vs 8.0 ± 2.3, p < 0.0001). Contrary to the agreement with Fcal and the performances of IUS to identify the need for therapeutic escalation, the duration of IUS procedure decreased over time (correlation coefficient = -0.54, p = 0.001) and plateaued between 15 and 20min-long from the 24th procedure. IUS and fecal calprotectin do not give the same information and could be complementary to monitor patients with CD.

Utility of Common Bile Duct Identification on Biliary Ultrasound in Emergency Department Patients.

Biliary ultrasound is often utilized in the evaluation of abdominal pain in the Emergency Department (ED). Common bile duct (CBD) identification is traditionally a standard component of the biliary ultrasound examination but can be challenging to perform for the novice sonographer. Previous work has demonstrated that CBD dilatation is rare in cases of cholecystitis with normal liver function tests (LFTs). We sought to assess the frequency of CBD dilatation in the subset of ED patients undergoing hepatobiliary ultrasound who have normal LFTs and an absence ofgallstones or biliary sludge on ultrasound.We also performed an assessment of changes in CBD diameter by age and cholecystectomy status. This was a retrospective chart review at a single academic ED. Patients were enrolled in the study if they underwent a radiology performed (RP) hepatobiliary ultrasound within the 2 year study period. Records were reviewed for the presence of gallstones or sludge, CBD diameter, age, clinical indication for the ultrasound, and LFTs. Descriptive analyses were performed, and interobserver agreement among data abstractors was assessed by K analysis for the presence of CBD dilatation. The Mann-Whitney test was utilized to assess statistical significance in the comparison of differences between CBD diameters amongst age groups. Of 1929 RP hepatobiliary ultrasounds performed in the study period, 312 were excluded and 1617 met inclusion criteria. Amongst these, there were 506 patients who had normal LFTs and an ultrasound with no stones or sludge. Ten patients within this group had a dilated CBD > 7 mm (1.98%, 95% CI of 1.08% to 3.6%). We also noted a statistically significant increase in CBD size in the older age cohort and in those individuals with a history of cholecystectomy. CBD dilation in ED patients who present with normal LFTs and an absence of gallstones and biliary sludge is rare. Physicians should be reassured that the routine identification of the CBD on ultrasound in this setting is of low yield and need not be pursued.

Evaluating the Feasibility of Using a Tele-Mentoring Model in Performing a Two-Point Deep Vein Thrombosis (DVT) Ultrasound Scan with Novice Sonographers

Evaluating the Feasibility of Using a Tele-Mentoring Model in Performing a Two-Point Deep Vein Thrombosis (DVT) Ultrasound Scan with Novice Sonographers

Is 1 Day of Focused Training in Echocardiographic Assessment Using Subxiphoid-Only (EASy) Examination Enough? A Tertiary Hospital Response to the COVID-19 Crisis and the Use of the EASy Examination to Support Unit-Wide Image Acquisition.

We assessed the efficacy of 1-day training in echocardiography assessment using subxiphoid-only (EASy) followed by supervised image interpretation and decision-making during patient rounds as a novel approach to scaling up the use of point-of-care ultrasound (POCUS) in critically ill patients. Retrospective analysis of medical records and EASy examination images. Tertiary care academic hospital. A total of 14 adults (> 18 yr old) with COVID-19-associated respiratory failure under the care of Albany Medical Center's surge response team from April 6-17, 2020 who received at least one EASy examination. Residents (previously novice sonographers) were trained in EASy examination using 1 day of didactic and hands-on training, followed by independent image acquisition and supervised image interpretation, identification of hemodynamic patterns, and clinical decision-making facilitated by an echocardiography-certified physician during daily rounds. We recorded the quality of resident-obtained EASy images, scanning time, and frequency with which the supervising physician had to repeat the examination or obtain additional images. A total of 63 EASy examinations were performed; average scanning time was 4.3 minutes. Resident-obtained images were sufficient for clinical decision-making on 55 occasions (87%), in the remaining 8 (13%) the supervising physician obtained further images. EASy examination is an efficient, valuable tool under conditions of scarce resources. The educational model of 1-day training followed by supervised image interpretation and decision-making allows rapid expansion of the pool of sonographers and implementation of bedside echocardiography into routine ICU patient management.

Drowning rule-out with novices (DROWN) in ultrasound.

Non-fatal drownings confer significant morbidity and mortality in the United States. Chest radiograph (CXR) is typically used as a screening modality for interstitial edema but lacks sensitivity early after submersion. No study has evaluated lung ultrasound in assessing for pulmonary edema after submersion events and we hypothesized that lung point-of-care (POC) ultrasound can identify interstitial edema in patients presenting after non-fatal drownings. Patients presenting to the emergency department after a submersion event were eligible if a CXR was obtained as part of their care. Emergency medicine residents performed a lung POC ultrasound and provided a "novice" interpretation of "normal" or "abnormal," which was independently reviewed by a blinded expert sonographer. Patients were contacted 2 weeks after presentation to assess for late sequela. A prospective convenience sample of 59 patients included 21 adults (36%) and 38 children (64%) enrolled over 17 months with a median age of 6. Twenty-four (41%) patients had abnormalities on CXR. Of these, 20 patients had a positive ultrasound per novice interpretation. Compared to CXR, ultrasound had an overall sensitivity of 83% and a specificity of 66% for detecting pulmonary edema in non-fatal drownings. Notably, out of 35 subjects with a negative CXR, there were 12 (34%) cases with a positive lung ultrasound, 10 of which required hospital admission. Lung POC ultrasound has a moderate sensitivity and specificity when performed by novice sonographers to detect pulmonary edema presenting to an ED setting after a non-fatal drowning event.

Accuracy of Emergency Medicine Residents Using Point-of-Care Ultrasound (POCUS) to Detect Retained Stingray Barbs

BackgroundStingray envenomation is a common presenting complaint for coastal emergency departments in the United States. Currently, radiograph is the gold standard to evaluate for a retained stingray barb, but ultrasound may be a useful tool to detect retained barbs. ObjectiveTo determine if emergency medicine residents could use ultrasound to identify stingray barbs embedded in animal tissue models. A secondary objective was to determine if resident experience affected their ability to detect stingray barbs. MethodsThirty-two emergency medicine residents participated in the study. After a short didactic session on foreign body identification with ultrasound, they rotated through six simulation stations and were asked to identify whether a stingray barb was present in pig and chicken tissue models. They were given 2 min per model to identify the presence, size, and depth of a stingray barb. Pre- and postexperiment surveys were collected to assess the residents’ level of experience and confidence regarding foreign body identification using ultrasound. ResultsResidents accurately identified barbs in chicken drumsticks with a sensitivity of 72.92% (95% confidence interval [CI] 63.89–81.48) and a specificity of 64.58% (95% CI 54.16–74.08), and in pig's feet with a sensitivity of 50.00% (95% CI 39.62–60.38) and specificity of 68.75% (95% CI 58.48–77.82). There was no statistically significant difference regarding accuracy for any outcome measured based on experience or level of training. ConclusionsThe use of point-of-care ultrasound by novice sonographers lacks sensitivity to identify retained stingray barbs in animal models and is not significantly impacted by resident experience with point-of-care ultrasound.

Motorized 3D Ultrasound and Jugular Vein Dimension Measurement on the International Space Station.

BACKGROUND: Internal jugular vein (IJV) congestion occurs during spaceflight. Historically, IJV distension on the International Space Station (ISS) has been quantified using single slice cross-sectional images from conventional 2D ultrasound with remote guidance. Importantly, the IJV is an irregular shape and highly compressible. Consequently, conventional imaging is susceptible to poor reproducibility due to inconsistent positioning, insonation angle, and hold-down pressure, especially when controlled by novice sonographers (i.e., astronauts). Recently, a motorized 3D ultrasound was launched to the ISS that mitigates angulation errors and has a larger design, allowing for more consistent hold-down pressure and positioning. This short communication compares IJV congestion measured with 2D vs. 3D methods during spaceflight.METHODS: IJV was measured prior to and following a 4-h venoconstrictive thigh cuff countermeasure. Data were acquired from three astronauts approximately halfway through their 6-mo missions.RESULTS: The 2D and 3D ultrasound results were not congruent in all astronauts. 3D ultrasound confirmed that the countermeasure reduced IJV volume in three astronauts by approximately 35%, whereas 2D data were more equivocal. These results indicate that 3D ultrasound provides less error-prone quantitative data.DISCUSSION: These data are the first to compare 2D and 3D methods during spaceflight in the same participants by using a known countermeasure that reduces IJV congestion. The current results demonstrate that 3D ultrasound should be the preferred imaging method when trying to measure venous congestion in the IJV, and that 2D ultrasound results should be interpreted with caution.Patterson C, Greaves DK, Robertson A, Hughson R, Arbeille PL. Motorized 3D ultrasound and jugular vein dimension measurement on the International Space Station. Aerosp Med Hum Perform. 2023; 94(6):466-469.

A 3D-Printed Ultrasound Task Trainer for the Practice of Hip Joint Injections

Ultrasonography is often the preferred method of imaging for needle-guided procedures of the hip joint, including aspirations, local anaesthetic injections, and the use of corticosteroids. Phantoms (i.e., training devices mimicking human tissue and bony structures under acoustic sonography) are used to help train medical professionals to perform these procedures accurately, emphasising the art of physical simulation in unison with didactic learning. In the authors’ study, 3D printing technology was used to simulate an anatomically accurate human hip joint, with the hopes of creating an affordable and customisable ultrasound hip trainer, allowing novice sonographers to practice guided injections to hone their skills before performing these procedures on human subjects.

Impact of focused cardiac and lung ultrasound screening performed by a junior doctor during admission to the surgical ward on patients before emergency non-cardiac surgery: A pilot prospective observational study.

To assess whether pre-operative focused cardiac ultrasound and lung ultrasound screening performed by a junior doctor can change diagnosis and clinical management of patients aged ≥65 years undergoing emergency, non-cardiac surgery. This pilot prospective observational study included patients scheduled for emergency, non-cardiac surgery. The treating team completed a diagnosis and management plan before and after focused cardiac and lung ultrasound, which was performed by a junior doctor. Changes to diagnosis and management after ultrasound were recorded. Ultrasound images were assessed for image and diagnostic interpretation by an independent expert. There was a total of 57 patients at age 77 ± 8 years. Cardiopulmonary pathology was suspected after clinical assessment in 28% vs. 72% after ultrasound (including abnormal haemodynamic state in 61%, valvular lesions in 32%, acute pulmonary oedema/interstitial syndrome in 9% and bilateral pleural effusions in 2%). In 67% of patients, the perioperative management was changed. The changes were in fluid therapy in 30%, cardiology consultation in 7%, formal in- or out-patient, transthoracic echocardiography in 11% and 30% respectively. The impact of pre-operative focused cardiac and lung ultrasound on diagnosis and management of patients on the hospital ward before emergency non-cardiac surgery by a junior doctor was comparable to previous studies of anaesthetists experienced in focused ultrasound. However, the ability to recognise when image quality is insufficient for diagnosis is an important consideration for novice sonographers. Focused cardiac and lung ultrasound examination by a junior doctor is feasible and may change preoperative diagnosis and management in patients of 65 years or older, admitted for emergency non-cardiac surgery.

Mnemonics and Metaphorical Videos for Teaching/Learning Musculoskeletal Sonoanatomy.

Musculoskeletal ultrasonography, despite various advantages, is a user-dependent modality. There are several approaches to facilitate the learning process of novice sonographers, for example, on-site courses, textbooks, and online lectures. However, the need for specific (sono)anatomy knowledge can be an obstacle, particularly in the beginning. With the aim of helping novice sonographers understand and retain topographic (sono)anatomy, we have prepared this article that follows a modern approach to teaching known as "entertainment education." It consists of images, schematic drawings, and multimedia videos that provide a simple, visual explanation accompanied by auditory content.

Evaluation of post-simulation sonographer students' professional behaviour in the workplace

IntroductionIn Australia, sonographer's professional identity is traditionally ‘caught’ from clinical role models. A four-year undergraduate-postgraduate course introduced professional identity education, with simulated practice, to prepare novice sonographer students prior to clinical practice. Preclinical students learnt sonographer professional behaviour, and humanistic attributes, during simulation designed with volunteer peers as standardised patients, educator role-models, immediate feedback, self-reflection, and longitudinal multi-observer assessment. This paper reports on the transfer of learnt professional behaviour and humanistic attributes to clinical practice. MethodsProfessional behaviour evaluations completed by 94 clinical assessors described 174 students' professional behaviour and attributes one month into their initial clinical practice (2015-6). Student performance of each behaviour, and behavioural category, was quantitatively analysed by modelling binomial proportions with logistic regression. ResultsStudents demonstrated substantial learning transfer to clinical practice, achieving an overall mean score of ‘consistent’ sonographer professional behaviour and humanistic attributes (mean score of equal to or >3/4), one month into clinical practice. Professional behaviours varied in transferability, with ‘response to patient's questions' showing least efficacy (P < 0.05). Increased deliberate practice with educator role-models improved transfer efficacy significantly (P < 0.001). ConclusionPreclinical application of theory to simulated practice, using standardised patients, educator role-models, immediate feedback, and multi-observer assessment, facilitated substantial transfer of sonographer professional behaviour and attributes to clinical practice. The efficacy of transfer varied but improved with increased deliberate practice and feedback. Implications for practiceThe incorporation of preclinical professional behaviour education with simulated practice into the core curriculum of sonographer courses is recommended for the formation of sonographer professional identity, improved clinical outcomes and increased patient safety during the early stages of ultrasound education.

Comparison of saline versus air for identifying endotracheal intubation with ultrasound

IntroductionAfter intubation has been performed, it is important to rapidly confirm the correct location of the endotracheal tube (ETT). Multiple techniques have been described, each with different limitations. Ultrasound has been increasingly recognized as an alternate modality for identifying the ETT location. However, it can be challenging to visualize the air-filled ETT cuff. Saline insufflation of the ETT cuff has been suggested to improve visualization of the ETT but data are limited. Our study sought to compare the diagnostic accuracy of air versus saline ETT cuff inflation on the diagnostic accuracy of intubation. MethodsThis was a randomized trial comparing air versus saline cuff inflation using a cadaver model. Adult cadavers were intubated in a random sequence with respect to both the location of intubation (i.e., tracheal vs esophageal) and air versus saline. Blinded sonographers assessed the location of the ETT using the static technique. Outcomes included accuracy of sonographer identification, time to identification, and operator confidence. Results480 total assessments were performed. When using air, ultrasound was 95.8% sensitive (95% CI 90.5% to 98.6%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 8.5 s (95% CI 7.6 s to 9.4 s) and a mean operator confidence of 4.32/5.0 (95% CI 4.21 to 4.42). When using saline, ultrasound was 100% sensitive (95% CI 97.0% to 100%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 6.3 s (95% CI 5.9 s to 6.8 s) and a mean operator confidence of 4.52/5.0 (95% CI 4.44 to 4.60). ConclusionThere was no statistically significant difference between air versus saline for intubation confirmation. However, saline was associated with fewer false negatives. Additionally, time to confirmation was faster and operator confidence was higher with the saline group. Further studies should determine if the outcomes would change with more novice sonographers or in specific patient populations.

Reference ranges of fetal cisterna magna volume measurements by three-dimensional ultrasonography in the late second trimester considering sonographic experience.

Volume measurements of fetal cisterna magna (CM) by three-dimensional (3D) ultrasonography may have a role in the diagnosis of various posterior fossa abnormalities. To evaluate reference intervals and reliability of fetal CM volume values by virtual organ computer-aided analysis (VOCAL) in structurally normal fetuses, considering experience of evaluators. Three operators with different 3D sonography experience levels measured CM volumes of 100 structurally normal fetuses at 18-27 weeks of gestation. Reference intervals for CM volumes were generated. Intraclass correlation coefficients (ICC) were calculated. Mean fetal CM volume measurements by the three operators did not significantly (P = 0.49, P = 0.22, and P = 0.17, respectively) change through 20-23 weeks of gestation. Moderate degrees of inter-observer reliability were found with an ICC of 0.69 between novice and intermediate-level, ICC of 0.74 between experienced and intermediate-level, and ICC of 0.78 between experienced and novice observer, respectively. The novice sonographer generally overestimated CM measurements. Intra-observer reliability was good (ICC=0.85). A reference chart for fetal CM volume by VOCAL was formed, revealing uniform mean values of 20-23 weeks of gestation. The inter-observer reliability is moderate, and biases seem relatively common for all experience categories.

Let’s Measure the Liver Better: A Pilot Study Assessing Inter-Rater Reliability When Measuring the Liver Volume Using Sonography

Objective: When measuring the liver sonographically, liver volume measurement (LVM) is not routinely performed, though considered the gold standard on CT. The objective of this study is to encourage the sonography community to obtain an LVM instead of a single linear measurement on ultrasound, so as not to subject patients to the potentially harmful radiation exposure of a CT scan when assessing liver size. This study compared the consistency and accuracy between expert and novice sonographers in obtaining an LVM on sonography. Materials and Methods: Both groups obtained linear and LVM on 30 participants and calculated LVM using the formula Liver Volume (cc) = 343.71 + (0.84 × ABC). Results: Both groups took longer to obtain LVM than linear, P &lt; .0001. Novices and experts obtained an LVM in a similar amount of time. More consistency was observed among experts when scanning participants in the lower BMI ranges. Novice sonographers’ LVMs were consistent with experts’ only in the lowest BMI range of this study. Conclusion: Groups acquired LVM in similar amounts of time, showing LVM is easy to teach and learn, and has good inter-rater reliability. Difference for both groups to obtain LVM over linear was only 38 seconds. Consequently, it is prudent to incorporate LVM into abdominal ultrasound protocols.

Tricuspid Regurgitant Jet Velocity Point-of-Care Ultrasound Curriculum Development and Validation.

The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ). We were unable to find a published curriculum to deliver education for this at any skill level. Therefore, we developed, delivered, and evaluated a curriculum for the assessment of TRJ for novice physician sonographers. We designed an educational intervention for novice physician sonographers. The curriculum was created using a modified Delphi methodology. All novice sonographers participated in the educational intervention which consisted of a didactic lecture followed by hands-on-deliberate practice on healthy medical student volunteers with expert feedback in a simulated setting. Sonographer's knowledge was assessed at 3 time points: pre-intervention, immediately post-intervention, and 3 months post-intervention (retention assessment) by multiple choice exam. Nine novice physician sonographers participated in the intervention. Mean exam performance increased from 55.6% [standard deviation (SD) 11.3%] on the pre-intervention exam to 94.4% (SD 7.3%) on the post-intervention exam and 92.9% (SD 12.5%) on the retention exam. The mean improvement between the pre- and post- exam was +38.9% (95% CI 31.8 - 46.0), and between the pre-exam and retention exam +37.1% (95% CI 22.3 - 52.0). Sonographer knowledge of TRJ assessment improved following a brief educational intervention as measured by exam performance. Given the expanding role of POCUS it is increasingly important to provide effective resources for teaching these skills. This work establishes the basis for further study and implementation of our TRJ curriculum.

The Influence of Sonographer Experience on Skeletal Muscle Image Acquisition and Analysis.

The amount of experience with ultrasonography may influence measurement outcomes while images are acquired or analyzed. The purpose of this study was to identify the interrater reliability of ultrasound image acquisition and image analysis between experienced and novice sonographers and image analysts, respectively. Following a brief hands-on training session (2 h), the experienced and novice sonographers and analysts independently performed image acquisition and analyses on the biceps brachii, vastus lateralis, and medial gastrocnemius in a sample of healthy participants (n = 17). Test–retest reliability statistics were computed for muscle thickness (transverse and sagittal planes), muscle cross-sectional area, echo intensity and subcutaneous adipose tissue thickness. The results show that image analysis experience generally has a greater impact on measurement outcomes than image acquisition experience. Interrater reliability for measurements of muscle size during image acquisition was generally good–excellent (ICC2,1: 0.82–0.98), but poor–moderate for echo intensity (ICC2,1: 0.43–0.77). For image analyses, interrater reliability for measurements of muscle size for the vastus lateralis and biceps brachii was poor–moderate (ICC2,1: 0.48–0.70), but excellent for echo intensity (ICC2,1: 0.90–0.98). Our findings have important implications for laboratories and clinics where members possess varying levels of ultrasound experience.

90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat

Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients &amp;gt;6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (&amp;lt;1cm or &amp;gt;1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.

Independent learning of the sonographic FAST exam technique using a tablet-based training module.

The aim of this study is to determine if a specific tablet-based training module can be used as an effective tool for independently training novice sonographers in the components of the focused assessment for sonography in trauma (FAST) exam. Participants attended a 15-minute orientation presentation followed by a 2-hour ultrasound scanning workshop where they used a novel tablet-based training module to learn the components of the FAST exam independently. This study took place at an accredited United States college of osteopathic medicine. Thirty-two first-year medical student volunteers without any prior ultrasound training in abdominal scanning. Training activities included brief didactic training and participation in an independent learning FAST exam workshop. Participants filled out subjective pre- and post-training self-confidence questionnaires and were objectively assessed and scored on their scanning skills. Comparison of the pre- and post-training subjective questionnaires showed a statistically significant (p < 0.001) increase in participant confidence in performing all components of the FAST exam. During skill evaluation, participants collectively demonstrated correct technique in 366 (82 percent) of the 448 total FAST exam scanning tasks they attempted. Based on these findings, the authors believe that learning to perform the FAST exam with this digital training module is an effective means of independently acquiring ultrasound skill. Digital ultrasound training modules like this one could have several useful applications, such as serving as an educational resource, or functioning as a point-of-care scanning adjunct to medical professionals in underdeveloped and rural areas where formal ultrasound training is not available.

Diagnostic Accuracy of Point-Of-Care Ultrasound for Intussusception Performed by Pediatric Emergency Medicine Physicians.

Intussusception (INT) is a common cause of bowel obstruction in young children. Delay in diagnosis can lead to significant morbidity and mortality. There have been several studies evaluating early point-of-care ultrasound (POCUS) in the diagnosis of INT by nonradiologists. Our objective was to determine the diagnostic accuracy of POCUS by novice sonographer pediatric emergency medicine physicians (PEM-Ps) who received focused US training for diagnosing INT. We performed a prospective observational study including 17 PEM-Ps (14 attendings, 3 fellows) trained to perform abdominal US for INT. Children suspected of having INT received POCUS performed and interpreted by a PEM-P, followed by a US study performed by a certified ultrasonographer and interpreted by an attending pediatric radiologist. Diagnostic concordance between PEM-P-and radiology-performed US (RPUS) results was assessed. One hundred patients were enrolled; median patient age was 24months. There was excellent diagnostic agreement for presence or absence of INT between PEM-Ps and RPUS (97% of cases; κ=0.826). POCUS-diagnosed INT was present in 8 of 9 patients with RPUS-diagnosed INT (sensitivity 89%; 95% confidence interval [CI] 51-99%; specificity 98%; 95% CI 92-100%; positive predictive value 80%; 95% CI 44-96%; negative predictive value 99%; 95% CI 93-100%). Likelihood ratio for INT with a positive POCUS was 40.44 (95% CI 10.07-162.36) and with a negative POCUS was 0.11 (95% CI 0.02-0.72). POCUS performed by novice sonographers to diagnose INT has high diagnostic concordance with RPUS. Emergency department-performed POCUS is a rapid and accurate method for diagnosing INT.

Real-Time Remote Tele-Mentored Echocardiography: A Systematic Review.

Background and Objectives: Real-time remote tele-mentored echocardiography (RTMUS echo) involves the transmission of clinical ultrasound (CU) cardiac images with direct feedback from a CU expert at a different location. In this review, we summarize the current uses of RTMUS to diagnose and manage cardiovascular dysfunction and discuss expanded and future uses. Materials and Methods: We performed a literature search (PubMed and EMBase) to access articles related to RTMUS echo. We reviewed articles for selection using Covidence, a web-based tool for managing systematic reviews and data were extracted using a separate standardized collection form. Results: Our search yielded 15 articles. Twelve of these articles demonstrated the feasibility of having a novice sonographer mentored by a tele-expert in obtaining a variety of cardiac ultrasound views. The articles discussed different technological specifications for the RTMUS system, but all showed that adequate images were able to be obtained. Overall, RTMUS echo was found to be a positive intervention that contributed to patient care. Conclusion: RTMUS echo allows for rapid access to diagnostic imaging in various clinical settings. RTMUS echo can help in assessing patients that may require a higher level of isolation precautions or in other resource-constrained environments. In the future, identifying the least expensive way to utilize RTMUS echo will be important.