Ultrasound First

We previously reported on AIUM’s Ultrasound First initiative back in March. Since then a number of helpful articles have been published in the Journal of Ultrasound in Medicine, each highlighting the utility of ultrasound as the primary imaging modality.

Thus far, topics include:

Sonography in Postmenopausal Bleeding – Steven R. Goldstein, MD

Think Ultrasound When Evaluating for Pneumothorax – Vicki E. Noble, MD

Sonography Should Be the First Imaging Examination Done to Evaluate Patients With Suspected Endometriosis – Beryl R. Benacerraf, MD, and Yvette Groszmann, MD

Sonography of Adenomyosis – Khaled Sakhel, MD, and Alfred Abuhamad, MD

Lung Ultrasound in Evaluation of Pneumonia – Michael Blaivas, MD

Ultrasound-Guided Interscalene Blocks – Andrew Gorlin, MD, and Lisa Warren, MD

Sonography for Surveillance of Patients With Crohn Disease – Kerri L. Novak, MSc, MD, FRCPC, and Stephanie R. Wilson, MD, FRCPC

Sonography as the First Line of Evaluation in Children With Suspected Acute Appendicitis – Leann E. Linam, MD, and Martha Munden, MD

Shoulder Sonography: Why We Do It – Sharlene A. Teefey, MD

Sonographically Guided Enema for Intussusception Reduction: A Safer Alternative to Fluoroscopy – Thomas Ray S. Sanchez, MD, Aaron Potnick, MD, Joy L. Graf, MD, Lisa P. Abramson, MD and Chirag V. Patel, MD

Sonography First for Subcutaneous Abscess and Cellulitis Evaluation – Srikar Adhikari, MD, RDMS, and Michael Blaivas, MD

Sonography in the Treatment of Calcific Tendinitis of the Rotator Cuff – Gregory R. Saboeiro

More articles on best evidence are forthcoming- please check out Ultrasoundfirst.org for more information!

On November 11-12, AIUM will host its first Ultrasound First Forum in New York City.

Intubation devices

Many new developments in ultrasound were demonstrated at the ACEP conference in Denver this week. Since airway management rivals ultrasound as my academic interest, I’d like to focus for a moment on an intubating device I saw demonstrated at an ultrasound vendor booth.  I’ve seen lots of organs on my ultrasound screen- hearts, gallbladders, eyeballs, prostates. I’ve even seen airway structures, but not like this:

The VividTrac is a single use, USB video intubation device. It is a channeled blade video laryngoscope similar in concept to the King Vision or the AirTraq Optical Laryngoscope. The channel is designed to pass the endotrachel tube through. This is in contrast to non-channeled video laryngoscopes like the Storz C-MAC or the Verathon Glidescope, where the endotracheal tube is guided with a stylet and not directed through the video device itself.

What is interesting about the Vivid device is it hooks up to a monitor using a standard USB cable. Thus, it can be connected to different types of monitors, PDAs or tablets which accept USB input, or… an ultrasound machine monitor! Theoretically one could use an existing ultrasound machine with a variety of probe types as well as a device like this.

There are many device manufacturers involved in R&D of devices which might lead to a technology convergence. Ultrasound probes, video intubation devices, cardiac monitoring equipment, etc. could all transmit images to a monitor, via wires or wirelessly. Thus, pluripotent monitors could be used with a variety of devices depending on the needs of any given patient. This could increase the amount of information relayed via the monitors, and even what is transmitted to the electronic medical record. Importing vital signs, ultrasound images, EKGs, or other clinical images could all be captured in this way. It will be interesting to see how many other devices can learn to communicate with each other as the technology develops.

Ultrasound Awareness Month

As a part of Ultrasound Awareness Month we’d like to let providers of all levels know about membership opportunities with national and international organizations.

They offer an enormous amount of information for providers at all levels; from the first time Sonographer to the Ultrasound Director and offer forums and support for all your Ultrasound-related endeavors.

Please visit the following websites for more information and/or follow them on twitter to interact with them in real time. We have included links to student, resident, or fellow membership options where applicable. Be sure to check out special rates, courses, and benefits in all of these organizations designed tom promote inclusion of providers at all levels!

ACEP US Section (US Section President @GeriaSonoMD)


AIUM (@AIUM_Ultrasound)

Winfocus (@Winfocus)

Society of Ultrasound in Medical Education (@SUSMEORG)

And of course…SinaiEM.US (@SinaiEMUS)

ATLS 9th Edition

The 9th Edition of Advanced Trauma Life Support(ATLS) has incorporated some important changes, one of which directly impacts the world of point-of-care ultrasound. There is increased emphasis on the FAST examination, and Diagnostic Peritoneal lavage (DPL) is now optional. According to the ATLS 9th Edition Compendium of Changes,

Either DPL or FAST must be taught during the surgical skill station as a method of evaluating the abdomen as a source of hemorrhagic shock

DPL was a required skill station in the ATLS 8th Edition; it is now optional.

Further Reading:

  • McKenney M, Lentz K, Nunez D, et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J Trauma. 1994 Sep; 37(3):439-41. (PMID: 8083906)
  • Farahmand N, Sirlin CB, Brown MA, Hypotensive patients with blunt abdominal trauma: performance of screening US. Radiology. 2005 May; 235(2):436-43. (PMID: 15798158)

Presentations-slide sorter view

We mostly focus on ultrasound here, but a large part of what we do is information exchange, adult education, and the like. We give a lot of presentations, and many of our faculty are interested in the art of speaking, the aesthetics of presentation design, and adult education.

So from time to time we’ll post on presentation-related topics; I hope you find them as useful as we do.

Slide Sorter View

When I’m polishing a talk, I like to look at the slides in Slide Sorter view. I use PowerPoint; Keynote calls this view Light Table. If you are using Prezi, just close your eyes and spin around 20 times really fast. That’s how your audience feels. Now stop it.

Slide sorter has many uses- right now I want to focus on using it as a final litmus test for how interesting your talk is going to be. If you have crafted an engaging presentation, you’ll be able to tell pretty quickly based on this “big picture” view of your content.


Here’s the slide sorter view of a talk I gave during residency. The topic was cyanide poisoning, but it doesn’t really matter. Do you want to hear this talk? I don’t. Take a minute and imagine what this talk will sound like. If you pull out this slide deck (I’m deliberately using that archaic term), you have lost before you started. You could read this in your best Ben Stein monotone, or bend over and speak the words out of your butt like Ace Ventura. It doesn’t matter. We’ve all seen this type of talk a million times. A resident reads some articles, pastes data into the slides without fully assimilating the information themselves. Then we have to listen to them tell us something we could read for ourselves. The resident (in this case, my past self), has taken a dry topic and kept it dry.


In contrast, here’s a talk I recently gave as part of Sinai’s White Coat ceremony day. What was the topic? Again it doesn’t matter. Look at the slides. Are you curious to find out what was said?

What’s that wooden tube? Will the boat catch the submarine? Why is that guy in a bathtub? The visuals here are just a part of the process. Hopefully they are designed to augment what is being said by the speaker. Hopefully there is real content here and it’s not just a bunch of pictures. But at least the speaker and audience are not engaged in a race to read through the words on the slides. That’s a race no one wins.

How to use this

The Slide Sorter test is among the last things I check. It’s like looking at yourself in the mirror as you leave the house. You should already have combed your hair and buttoned your fly by then, but the mirror will let you know before it’s too late. There’s an art and science to slide design, which starts way before this. But this is a simple final check.

Slide Sorter view is also very helpful in rearranging slide order and keeping the threads of your talk together. Garr Reynolds, the presentation zen master, uses Slide Sorter view to storyboard his talks as he builds them.

If you haven’t tried this trick, compare your favorite and your worst talk using this view and see if you can spot any differences.


October 2012

October is Medical Ultrasound Awareness Month!

Medical Ultrasound Awareness Month is a joint effort of the American Institute of Ultrasound in Medicine (AIUM), American Registry for Diagnostic Medical Sonography (ARDMS), the American Society of Echocardiography (ASE), Cardiovascular Credentialing International (CCI), the Society of Diagnostic Medical Sonography (SDMS), and the Society for Vascular Ultrasound (SVU).


Ultrasound is any sound at a frequency that is above the range of human hearing. Diagnostic medical ultrasound uses high-frequency sound waves to create images of organs and structures inside the body, and is broken into several subgroups according to the specialized area of the body focused upon by a specific procedure. Ultrasound images of the heart are called echocardiograms, and the procedure is called echocardiography; ultrasound images of most other parts of the body are called sonograms, and the procedure is commonly called sonography. Ultrasound tests looking at blood vessels and blood flow are called noninvasive vascular ultrasound examinations. Unlike many other imaging procedures, ultrasound does not use x rays or other forms of ionizing radiation. An instrument called a transducer is placed against the body, and special gel helps transmit the sound. In most types of diagnostic medical ultrasound examinations, the transducer emits short bursts of sound, which bounce off a structure and return to the transducer. These echoes are processed by a computer, and the images they create are displayed on a monitor.


Physicians who interpret ultrasound examinations are called sonologists. Although many sonologists perform the tests themselves, they often employ highly skilled professionals called sonographers. These individuals have completed extensive, specialized education in the field of diagnostic medical ultrasound. Sonographers who specialize in cardiac ultrasound are called echocardiographers, and those who specialize in ultrasound of the blood vessels are called vascular technologists.
Although a sonographer may play a critical role in extracting the information necessary to derive a diagnosis, the rendering of a final diagnosis of an ultrasound study is the responsibility of the supervising sonologist.


Ask whether your sonographer is certified. Certified sonographers have demonstrated that they have specific training, experience, and  knowledge to perform an ultrasound examination safely and accurately. To maintain their certification, sonographers are required to earn  ontinuing medical education credits each year, which helps ensure that they remain up-to-date in ultrasound technology and patient care. Ask whether the ultrasound practice you are visiting is accredited. Facilities that have obtained accreditation have demonstrated competency in every aspect of their ultrasound operations, including the education and training of physicians and sonographers, calibration and maintenance of the ultrasound equipment, document storage, policies for safeguarding patients, and accuracy in diagnosis.


Diagnostic medical ultrasound should be used in a prudent manner to provide a medical benefit to the patient. Nonmedical use of ultrasound for psychosocial or entertainment purposes is strongly discouraged. The use of ultrasound only to view a fetus, obtain a picture of a fetus, or determine the fetal sex without a medical indication is inappropriate and contrary to responsible medical practice.


American Institute of Ultrasound in Medicine (AIUM) • 800-638-5352 • 301-498-4100
American Registry for Diagnostic Medical Sonography (ARDMS) • 301-738-8401
American Society of Echocardiography (ASE) • 919-861-5574
Cardiovascular Credentialing International (CCI) • 800-326-0268
Society of Diagnostic Medical Sonography (SDMS) • 800-229-9506 • 214-473-8057
Society for Vascular Ultrasound (SVU) • 301-459-7550

Ultrasound education at MSSM

The Mount Sinai School of Medicine recently welcomed its incoming first-year class in its traditional White Coat Ceremony. In a day filled with inspirational talks by prominent faculty and medical leaders, students don their new white coats and receive a stethoscope at a special ceremony attended by family, friends and faculty members.

This year, Sinai’s medical students were also introduced to a new curriculum in point-of-care ultrasound:

“First-year medical students traditionally learn about the human body by dissecting the cadavers and eventually by examining the patients, and the examination ranges from inspection and palpation to listening with the help of a stethoscope and interpreting the sounds of the heart, lungs and blood vessels,” says Jagat Narula, MD, PhD, who is the principal investigator of this research study and the director of the cardiovascular imaging program at Mount Sinai School of Medicine. “With handheld ultrasound, our medical students will have the ability to see live images of inside the body projected onto a handheld screen in real time.  It’s an innovative educational concept that can modernize medical education.”

As part of an educational research study, GE Vscan ultrasound machines will be distributed to groups of medical students who will learn to use the technology to image the heart, lungs, and abdomen. Mount Sinai is the first school in New York to initiate such a curriculum.

David Muller, MD, dean of medical education at Mount Sinai School of Medicine, says of the research study, “First-year medical students will learn how to identify and assess the anatomical structures within cardiac, thoracic and abdominal applications. We are excited to incorporate the portable ultrasound in our curriculum as we strive to revolutionize the way medicine is taught.”

The curriculum will augment what is being taught in the Art and Science of Medicine course, which is the students’ introduction to physical examination.

Bret Nelson, MD, RDMS, FACEP, associate professor and director of emergency ultrasound in the department of emergency medicine at Mount Sinai, will be leading the new curriculum with Dr. Narula. Says Dr. Nelson, “Point-of-care ultrasound represents a distinct skill set beyond physical examination. Te increased penetration of sonography through a variety of clinical practice environments means students will need to understand this technology to excel in patient care through their careers.”

FROM LEFT: Jagat Narula, MD, PhD; David Muller, MD; Mike Harsh, Vice President and Chief Technology Officer, GE Healthcare; Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Mount Sinai School of Medicine and Executive Vice President for Academic Affairs, The Mount Sinai Medical Center; Tom Gentile, President and Chief Executive Officer, GE Healthcare; Bret Nelson, MD; and Lisa Kennedy, Director, Strategic Marketing, healthmagination

“Today, we are thrilled to play a part in this important research project by providing Mount Sinai’s first-year medical students with the power of portable ultrasound technology, as they take the first step towards becoming our next generation of doctors,” says Tom Gentile, president and CEO of GE Healthcare Systems. “Tools like Vscan have the ability to help transform the physical exam and today’s announcement reaffirms GE Healthcare’s commitment to research and improving patient care by helping enhance the physician’s ability to quickly and accurately diagnose patients.”

For the full story, please check out the October 1 edition of Inside Mount Sinai.