Ultrasound Sessions Research Articles

The Role of Ultrasound Simulation in Obstetrics and Gynecology Training: A UK Trainees' Perspective.

Ultrasonography is a core skill required by all obstetrics and gynecology trainees; however, training opportunities in clinical ultrasound are declining. Simulation ultrasound training has been proposed as a strategy to overcome this.The study aims were to determine the current availability of clinical and simulation ultrasound training in obstetrics and gynecology in the United Kingdom and to explore the trainees' perspective on the role of ultrasound simulation. All obstetrics and gynecology trainees within the East Midlands Local Education Training Board in the United Kingdom were asked to complete an anonymous web-based survey in July 2014. Of 140 trainees, 70 (50%) responded to the survey, and 69% reported rarely having dedicated clinical ultrasound sessions. Fifty percent had failed to achieve ultrasound competencies required for their stage of training, and 83% felt that the pressures of service provision limited their exposure to clinical ultrasound.Seventy-three percent of the trainees considered ultrasound simulation to be an essential component of training, and 69% agreed that it would help improve their clinical skills. Only 50% had access to an ultrasound simulator. Seventy-seven percent of the trainees thought that it would be useful to have ultrasound simulation integrated into training. Trainees are struggling to achieve minimal ultrasound competences with clinical ultrasound training alone. They believe that ultrasound simulation will shorten the learning curve and improve their clinical skills and knowledge. Despite the cost implications of simulation training, we propose that consideration is given to formal integration of ultrasound simulation into the curriculum as a possible way forward.

Integrating Ultrasound Teaching into Preclinical Problem-based Learning.

Objectives:The aim is to provide students in the preclinical with ultrasound image interpretation skills. Research question: Are students in smaller groups with access to a combination of lectures and hands-on patient contact most likely to have better ultrasound image interpretation skills, than students in larger groups with only interactive didactic lectures?Methodology:First-year students at the preclinical Program of the College of Medicine, participated in two 2-h introductory interactive ultrasound sessions. The study comprised two cohorts: 2012/2013 students, who were offered large group teaching (LGT) sessions (control group), and 2013/2014 students, who received the intervention in small group learning problem-based learning (PBL) sessions (experimental group). The overall learning objectives were identical for both groups. The success of the module was evaluated using pre- and post-tests as well as students’ feedback.Results:The students in the experimental group showed significantly higher scores in interpretations of images than those in the control group. The experimental group showed achievement of learning outcomes along with higher levels of satisfaction with the module compared to the latter.Conclusion:Posttest knowledge of the basics of ultrasound improved significantly over the pretest in the experimental group. In addition, students’ overall satisfaction of the ultrasound module was shown to be higher for the PBL compared to the LGT groups. Small groups in an interactive and PBL setting along with opportunities for hands-on practice and simultaneous visualization of findings on a high definition screen should enhance preclinical student learning of the basics of ultrasound. Despite the potential of ultrasound as a clinical, teaching and learning tool for students in the preclinical years, standardized recommendations have yet to be created regarding its integration into the curricula within academic institutions and clinical medicine. The interactive and PBL is here to stay at the college of medicine. Further research would be carried out to see if this trend persists in the upcoming vertical system-based curriculum of the college of medicine.

Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

BackgroundA growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach.AimTo implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures.SettingThe study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns.Program descriptionThis was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention.ResultsThirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099.ConclusionsA single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

Using an abdominal phantom to teach urology residentes ultrasound-guided percutaneous needle placement.

ABSTRACTIntroduction:To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement.Materials and methods:University of California, San Francisco (UCSF) urology residents completed a time trial, placing a needle into a phantom model target under ultrasound guidance. Participants were randomized into three educational exposure groups: Group 1's time trial occurred prior to any teaching intervention, group 2's after experiencing a hands-on training module, and group 3's after exposure to both the training module and one-on-one attending feedback. Needle placement speed and accuracy as well as trainees' perceived confidence in utilizing ultrasound were measured.Results:The study cohort consisted of 15 resident trainees. Seven were randomized to group 1, three to group 2, and five to group 3. All residents reported minimal prior ultrasound experience. Their confidence in using ultrasound improved significantly after completing the training module with the most significant improvement seen among junior residents. Time to needle placement was fastest after receiving attending feedback (46.6sec in group 3 vs. 82.7sec in groups 1 and 2, p<0.01). Accuracy also improved with attending feedback, though the number of repositioning attempts did not differ significantly between groups.Conclusions:A hands-on training module and use of an abdominal phantom trainer increased resident confidence and skill in their use of ultrasound to guide percutaneous needle positioning. Attending feedback is critical for improving accuracy in needle guidance toward a target. Ultrasound-guided needle positioning is a teachable skill and can be applicable to multiple urologic procedures.

A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs.

Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process. The study was conducted on a group of 47 patients of both sexes, aged 38-60years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire. However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1week of beginning treatment. More dynamic change in this period was recorded in Group 1. The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments.

Quantifying disease progression in amyotrophic lateral sclerosis using peripheral nerve sonography.

In this study we investigated whether peripheral nerve sonography could be used as a biomarker to monitor disease progression in amyotrophic lateral sclerosis (ALS). In 37 patients, ulnar and median nerve cross-sectional area (CSA) was determined in at least 2 ultrasound sessions; mean follow-up was 14.5 months. Linear mixed-effects models were conducted to analyze time effects on CSA. Ulnar nerve CSA declined significantly at a monthly rate of -0.04 mm(2) (forearm) and -0.05 mm(2) (wrist); the decrease was more pronounced when baseline CSA was greater. To detect a 50% treatment effect on ulnar nerve CSA, 332 patients would need to be entered in a hypothetical randomized, controlled clinical trial. Time had no significant impact on median nerve CSA. Distal ulnar nerve ultrasound may be a useful biomarker to monitor disease progression in ALS, especially as hypothetical treatment effects on CSA seem to be detectable in manageable cohort sizes. Muscle Nerve 54: 391-397, 2016.

Ultrasound-based lectures on cardiovascular physiology and reflexes for medical students.

Ultrasound has become a widely used diagnostic technique. While its role in patient evaluation is well known, its utility during preclinical courses such as anatomy and physiology is becoming increasingly recognized. The aim of the present study was to assess the feasibility/utility of integrating ultrasound-based sessions into conventional undergraduate medical school programs of physiology of the cardiovascular system and cardiovascular reflexes and to evaluate student perceptions of an ultrasound-based didactic session. Second-year medical students enrolled in the University of Padova attended a didactic session during which basic concepts regarding ultrasound instrumentation, image production, and spatial orientation were presented. Five anatomic sectors (the heart, aorta, neck vessels, inferior vena cava, and femoral veins) were then examined on a volunteer. Student perceptions of the images that were projected, the usefulness of the presentation, and the reproducibility of the experience were assessed at the end of the lecture with an anonymous questionnaire consisting of positive and negative items that were rated using a 5-point Likert scale and with two questions. One hundred eleven students attended the lecture; 99% of them found it very interesting, and none considered it boring or a waste of time. More than 96% thought it helped them to gain a better comprehension of the subject and would recommend it to a colleague. In conclusion, as ultrasound has been found to be a valuable resource for the teaching of physiology of the cardiovascular system and cardiovascular reflexes, efforts should be made to integrate ultrasound sessions into the traditional human physiology curriculum.

Evaluation of Homemade Ballistic Gelatin Phantoms as a Low-Cost Alternative to Commercial-Grade Phantoms in Medical Education

Cost limitations of commercial-grade ultrasound phantoms often prevent ultrasound education from being incorporated into medical curricula (Bahner et al., Acad Med. 89:1681–6, 2014). While production of homemade agar gelatin phantoms to offset costs has been well documented, use of ballistic gelatin has only recently been described (Domenico et al., J Ultrasound. 11 (4):135-42, 2008; Zerth et al., J Emerg Med. 43:1066-9, 2012; Chao et al., J Emerg Med. 45:240-3, 2013; Shobeiri et al., J Ultrasound Med. 32:1393-6, 2013; Woywodt et al., Clin Nephrol. 79:241-5, 2013; Zeiler et al., Can J Neurol Sci. 40:225-9, 2013; Hunt et al., Eur J Radiol. 82:594-600, 2013; Lo et al., Emerg Med J. 29:738-41, 2012; Li et al., J Ultrasound Med. 30:263-72, 2011; Morrow and Broder, J Emerg Med. 49 (3):313-7, 2015). There exists a critical need for learner evaluation of homemade ballistic gelatin phantoms (BGPs) and their comparison to commercial-grade phantoms to better inform BGP introduction into medical education. The primary aim of this study is to describe survey-based evaluation of homemade BGPs and commercial-grade Blue PhantomsTM by medical students. The secondary aim is to compare image quality of BGPs and Blue PhantomsTM. Described are construction of BGPs and introduction in voluntary ultrasound training sessions offered to 61 first through fourth-year medical students. The evaluation and success of this model are reported. Students reported that versatility of homemade BGPs surpassed that of commercially available phantoms (4.52 ± 0.71) and that they felt more confident in their ultrasound skills after the session (4.82 ± 0.37). Side-by-side evaluation of images generated using BGPs and Blue PhantomsTM had comparable simulated vessel shape and echogenicity, adding objective assessment to subjective survey-based results. Training sessions were enabled by low-cost homemade BGPs at $4 vs $400+ cost of commercial-grade phantoms, a 100-fold reduction in cost. As students found BGPs and Blue PhantomsTM comparable, the results of this study can equip other institutions struggling with costs of incorporating ultrasound into their medical curricula with not only a cost-effective solution but also a learner-validated one.

Sonography and hypotension: a change to critical problem solving in undergraduate medical education.

Study objectivesMultiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises.MethodsThis was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.ResultsOne hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00).ConclusionAt our institution, we successfully integrated ultrasound and critical problem-solving instruction, as part of a 1-day workshop for undergraduate medical education.

Reliability of ultrasound evaluation of the long head of the biceps tendon.

To determine the reliability of quantitative measures of the long head of the biceps tendon using an ultrasound-imaging system. Intra- and inter-rater reliability study. Thirty-one participants without shoulder pain. All participants took part in 3 ultrasound imaging sessions; they were assessed by 2 evaluators (inter-rater reliability), one of whom assessed them twice (intra-rater reliability). All measurements were taken at the widest identified part of the tendon using longitudinal and transverse views. Measurements of the long head of the biceps tendon included width, thickness and cross-sectional area. Intraclass correlation coefficients and minimal detectable change were used to characterize reliability. Intra- and inter-rater reliabilities were excellent for all measures when the mean of 2 measures were considered, except for inter-rater reliability of the width, for which it ranged from 0.76 to 0.86. Minimal detectable change ranged from 0.3 to 1.6 mm for width and thickness, and from 2.8 to 4.9 mm2 for cross-sectional area. Ultrasound measurement of the long head of the biceps tendon is a highly reliable method, except for the width. When measuring the long head of the biceps tendon, a mean of 2 measurements is recommended. Now that reliability has been shown in healthy individuals, the next step will be to determine the validity/reliability of these quantitative measures in symptomatic shoulders.

European Academy of Andrology Newsletter 2‐2015

s or, if open access is available, full texts are installed. The focus of this section is on news from ‘outside’ the EAA. An additional section of the new virtual library should reflect what is going on ‘inside’ EAA, and includes papers with high interest to our community published by the EAA centers. The papers are selected by the Centre directors. News from the EAA journal “Andrology” The first impact factor (IF) of “Andrology” has been released by the Thomson Reuters Web of Science. The IF is 2.3 and this figure is expected to increase next year because the first IF includes citations gathered within one year only (2014) to articles published during one year (2015), instead of the customary two-year period of citations and publications.

STEM-16SONODYNAMIC 5-ALA PLUS ULTRASOUND THERAPY AUGMENTS ANTI-TUMOR EFFECTS IN THE ONCOGENE KNOCK-IN GLIOMA STEM CELLS

STEM-16. SONODYNAMIC 5-ALA PLUS ULTRASOUND THERAPY AUGMENTS ANTI-TUMOR EFFECTS IN THE ONCOGENE KNOCK-IN GLIOMA STEM CELLS Kenji Shono, Teruyoshi Kageji, Yoshihumi Mizobuchi, Toshitaka Fujihara, Keiko Kitazato, Kohei Nakajima, Hideo Mure, Kazuyuki Kuwayama, and Shinji Nagahiro; Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima UniversityGraduateSchool, Tokushima City,Tokusima Prefecture, Japan INTRODUCTION: To overcome the chemoand radiation resistance of glioblastoma multiforme (GBM), new therapeutic strategies are needed. Sonodynamic therapy (SDT) is efficacious in several types of tumor and cancer. However, there are few studies in oncogene knock-in glioma stem cells (GSCs), which are thought to be implicated in the therapeutic resistance of GBM. We tested our hypothesis that SDT is effective in GSCs and GBM cells. METHODS: Using GSCs and U251 MG cells we assessed the efficacy of SDT in vitro. We also studied the anti-tumor effects of SDT in GSC-bearing mice. We compared the efficacy of SDT delivered in a single ultrasound session (1 MHz, 2W/cm) with the results obtained with 5-ALA delivered at 1 mM/well. RESULTS: While no significant effects were observed when cells were exposed to 5-ALA, ultrasound-treated cells lost viability immediately after exposure. SDT enhanced the effects of ultrasonography. Our findings suggest that SDT may be effective in GBM cells and GSCs. CONCLUSION: Ours is the first study to show the efficacy of SDT in GSCs. The mechanisms mediated by SDT and by photodynamic therapy may be different. Studies are underway to confirm the beneficial effects of SDT in GSC-bearing mice and to elucidate the mechanisms underlying its efficacy. Neuro-Oncology 17:v208–v213, 2015. doi:10.1093/neuonc/nov234.16 Published by Oxford University Press on behalf of the Society for Neuro-Oncology 2015.

Reliability of Ultrasound Imaging Measures of Transverse Abdominis and Lumbar Multifidus in Various Positions

ObjectiveTo determine the reliability of measurement of muscle activation via ultrasound imaging measures of the transverse abdominis (TrA) and lumbar multifidus (LM) in tabletop, seated, standing, and walking conditions. DesignDescriptive laboratory study. SettingUniversity research laboratory. ParticipantsSixteen healthy participants (age, 20.4 ± 1.8 years; height, 167.7 ± 9.0 cm; mass, 65.1 ± 10.8 kg). InterventionsNone. Main Outcome MeasurementsThe activation ratio (AR) of TrA and LM and preferential activation ratio of TrA in tabletop, seated, standing, and walking positions were assessed by the same examiner during 2 ultrasound imaging sessions 24-72 hours apart. Statistical analysis included determination of intraclass correlation coefficients (ICCs) using analysis of variance for each muscle and position between sessions. ResultsExcellent reliability was found in TrA AR between sessions for healthy participants in the tabletop position (ICC3,k = 0.903), and acceptable to excellent reliability was found in seated (ICC3,k = 0.613), standing (ICC3,k = 0.553), and walking (ICC3,k = 0.737) positions. LM AR was fair in the tabletop position for these participants (ICC3,k = 0.264). The preferential activation ratio for healthy participants was substantially reliable in tabletop and seated positions (ICC3,k = 0.668, 0.684) and showed fair reliability for walking (ICC3,k = 0.455). ConclusionsUltrasound imaging is a reliable method of measuring muscle thickness across multiple positions in healthy persons. This measure may be used to compare abdominal muscle thickness across populations or after interventions. LM AR was only found to be reliable in the tabletop position.

Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills.

To determine whether the addition of ultrasound to traditional physical examination instruction improves junior medical students' abilities to locate the femoral pulse. Initially, 150 second-year medical students were taught the femoral pulse examination using traditional bedside teaching on standardized patients and online didactic videos. Students were then randomized into 2 groups: group 1 received ultrasound training first and then completed the standardized examination; and group 2 performed the standardized examination first and then received ultrasound training. On the standardized patients, the femoral artery was marked with invisible ink before the sessions using ultrasound. Compared to these markers, students were then evaluated on the accuracy of femoral artery pulse palpation and the estimated location of the femoral vein. All students completed a self-assessment survey after the ultrasound sessions. Ultrasound training improved the students' ability to palpate the femoral pulse (P= .02). However, ultrasound did not facilitate correct estimation of the femoral vein's anatomic location (P = .09). Confidence levels in localizing the femoral artery and vein were equal between groups at baseline, and both increased after the ultrasound sessions. The addition of ultrasound teaching to traditional physical examination instruction enhanced medical student competency and confidence with the femoral vascular examination. However, understanding of anatomy may require emphasis on precourse didactic material, but further study is required.

Ultrasound-guided procedures in medical education: a fresh look at cadavers.

Demand for bedside ultrasound in medicine has created a need for earlier exposure to ultrasound education during the clinical years of undergraduate medical education. Although bedside ultrasound is often used for invasive medical procedures, there is no standardized educational model for procedural skills that can provide the learner a real-life simulated experience. The objective of our study was to describe a unique fresh cadaver preparation model, and to determine the impact of a procedure-focused ultrasound training session. This study was a cross-sectional study at an urban academic medical center. A sixteen-item questionnaire was administered at the beginning and end of the session. Fifty-five third year medical students participated in this 1-day event during their surgical clerkship. Students were trained to perform the following ultrasound-guided procedures: internal jugular vein cannulation, femoral vein cannulation femoral artery cannulation and pericardiocentesis. Preparation of the fresh cadaver is easily replicated and requires minor manipulation of cadaver vessels and pericardial space. Fifty-five medical students in their third year participated in this study. All of the medical students agreed that US could help increase their confidence in performing procedures in the future. Eighty percent (95 % CI 70-91 %) of students felt that there was a benefit of learning ultrasound-based anatomy in addition to traditional methods. Student confidence was self-rated on a five-point Likert scale. Student confidence increased with statistical significance in all of the skills taught. The most dramatic increase was noted in central venous line placement, which improved from 1.95 (SD = 0.11) to 4.2 (SD = 0.09) (p < 0.001). The use of fresh cadavers for procedure-focused US education is a realistic method that improves the confidence of third year medical students in performing complex but critical procedures.

Head and Neck Ultrasound Education-A Multimodal Educational Approach in the Predoctoral Setting: A Pilot Study.

With the increased implementation of ultrasound in medical education, it is important to continually improve instructional methods. In this study, we demonstrate that by augmenting the traditional methods of instructor demonstration and student practice on a healthy volunteer with additional modalities, such as didactic presentation, simulated pathologic cases, and simulated procedures, students gain a more comprehensive understanding of and confidence in ultrasound technique and pathology. A multimodal curriculum was developed and applied to head and neck ultrasound sessions of our institution's Ultrasound Symposium. Participants were asked to fill out surveys rating each instructional modality as well as preinstructional and postinstructional confidence. The survey results were divided into a group of first- and second-year medical students who had previous ultrasound training and a group of third- and fourth-year students who were ultrasound "naïve." The survey showed that the first- and second-year student group (n = 8) had an average preinstructional confidence of 4.14/10 compared to 1.44/10 in the third- and fourth-year student group (n = 9) (P = .003). Following the instructional sessions, the students' confidence increased respectively to 8.14/10 and 7.78/10 (P= .53), showing a 4.00 (96%) increase in the first- and second-year group and a 6.34 (440%) increase in the third- and fourth-year group. The combined results of all student teaching modality ratings showed that instructor demonstration was rated the highest (9.47) and computerized simulation lowest (8.25). Overall, our study shows that multimodal ultrasound instruction was beneficial in increasing both ultrasound-trained and ultrasound-naïve medical students' confidence in head and neck ultrasound.

Prediction of lethal pulmonary hypoplasia by means fetal lung volume in skeletal dysplasias: a three-dimensional ultrasound assessment

Objective: The aim of this study was to assess the capacity of three-dimensional ultrasound (3DUS) for predicting lethality in fetuses with skeletal dysplasia.Methods: Twenty-four fetuses between 20 and 32 weeks of gestation were assessed. Bilateral lung volume scans were performed three times in each fetus during one ultrasound session. The virtual organ computer-aided analysis method was used to obtain a sequence of six sections of each lung around a fixed axis, and a rotation angle of 30° was adopted. Fetal lung volume measurements were analyzed according to the reference range. After birth, lung hypoplasia was diagnosed considering clinical and radiological criteria.Results: Of all cases of skeletal dysplasia, 18 (75%) were lethal. Among the lethal cases, after postnatal diagnosis, four were osteogenesis imperfecta type II, three were thanatophoric dysplasia and two were campomelic dysplasia. The remaining nine cases remained without a definitive diagnosis. The accuracy of 3DUS in predicting lethality in fetuses with skeletal dysplasia was high, with a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 66.7%. The kappa index of 0.174 showed a good agreement between the possibility of lethality when the 3DUS volume measurement was altered and real lethality after birth (p < 0.001).Conclusion: This study suggests that the 3DUS lung volume measurement is a good predictor of lethal pulmonary hypoplasia in fetuses with skeletal dysplasia, with high accuracy.

Focused simulation training: emergency department nurses' confidence and comfort level in performing ultrasound-guided vascular access.

The objective of this study is to assess Emergency Department (ED) nurses' confidence, comfort level, and competency in performing ultrasound-guided vascular access after a focused ultrasound simulation training session. A cross-sectional study at an academic medical center. A simulation-based ultrasound training module was used to train ED nurses in ultrasound-guided intravenous (IV) access. The training module consisted of didactics followed by hands-on practice on human models and Blue Phantom ultrasound training block model. All subjects completed a questionnaire after completing the training module. A total of 40 nurses were enrolled. All subjects successfully demonstrated competency during the training session by identifying upper extremity sonographic vascular anatomy on a human model and performing real-time ultrasound-guided IV access on Blue Phantom ultrasound training block model. On a scale of 1-10, the average confidence level in performing the ultrasound-guided vascular access was 6.9 [95% confidence interval (95% CI) 6.3-7.46], with 98% (95% CI, 92-102%) reporting no difficulty in recognizing upper limb vascular anatomy on ultrasound. Ninety-two percent (95% CI, 84-100%) agreed that focused training in ultrasound-guided IV access was adequate to learn the procedure. After a focused simulation training session, ED nurses had a high level of comfort using ultrasound for vascular access. Despite having a moderate degree of confidence, ED nurses were accurate in identifying vascular anatomy and performing ultrasound-guided vascular access.

Scan When You Can: Using Open Ultrasound Practice Sessions as a Venue to Encourage Interprofessional Education

Recently many medical schools have introduced ultrasound education, with several institutions adopting formal teaching of ultrasound into their anatomy curricula. Additionally, medical schools nationwide have begun to incorporate various forms of interprofessional education (IPE) into their programs to prepare medical students for the teamwork necessary to serve as physicians. The Anatomy course at Mayo Medical School incorporated several IPE sessions with physical therapy students. Since the course is integrated with radiology, ultrasound imaging was recently added to complement static images and visualize living anatomy. Due to the success of prior IPE endeavors in anatomy, a new elective experience for hands‐on ultrasound practice sessions was offered to both medical and physical therapy students. The aim of this study was to assess student perception of elective ultrasound practice sessions as an opportunity for interprofessional peer‐learning. Practice sessions were scheduled once a week for 4 hours and a trained teaching assistant was available during the sessions. Students were encouraged to discuss different techniques and anatomical knowledge based on their respective experiences. A sign‐in sheet was kept to monitor how many students from both groups attended. Students were asked to fill out a survey at the end of 4 weeks to assess perceptions of the interprofessional experience. Preliminary results indicate that students appreciated the diversity of an interprofessional approach to learning ultrasound skills and enjoyed teaching each other anatomy through ultrasound.

Google Glass: Integrating Ultrasound with Anatomy

Google Glass is wearable technology that can supplement instruction for procedures and skills. Google Glass was used to create online instructional modules to conduct ultrasound scans of the hepatobiliary system. Ultrasound imaging is an important tool for physicians at the point of care that requires a working knowledge and understanding of anatomy. TTUHSC/SOM incorporates ultrasound in undergraduate medical education, integrating these skills with anatomical dissections to provide a method of visualizing anatomy in a clinical context. Ultrasound sessions were integrated with dissection sessions of the wrist, neck and liver. These exercises were assessed with five point pre‐ and post‐tests for each session and average student performance increased (p&lt;0.0001) from pre‐ to post‐test; wrist (2.71/4.20), neck (3.20/4.73), and liver (2.89/4.45). Student opinion was assessed by survey on a five‐point Likert scale. Improved understanding of anatomy scored 3.52 and students rated the Google Glass modules significantly higher (3.51, p&lt;0.01) than the previous modules (3.13). Students were neutral regarding their perceived confidence to utilize ultrasound on patients but indicated a desire for better skills assessment and more deliberate practice with ultrasound, which could be enhanced using Google Glass for individual instruction. This project was funded by the TTUHSC/SOM.