It truly is the year of ultrasound — and it isn’t even 2013 yet. Â Groundbreaking article on lung ultrasound by our JimÂ Tsung who found point of care ultrasound to be 86% sensitive and 89% specific in detecting pneumonia up to age 21. Â ePub is available ahead of print in JAMA’s Archives of Pediatric and Adolescent Medicine. Â Time to say goodbye to ionizing radiation!
Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults
Vaishali P. Shah, MD; Michael G. Tunik, MD; James W. Tsung, MD, MPH
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,â€ 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. â€œWith 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.Â Itâ€™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, â€œFirst-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.”
“Today, we are thrilled to play a part in this important research project by providing Mount Sinaiâ€™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,â€ says Tom Gentile, president and CEO of GE Healthcare Systems. â€œTools like Vscan have the ability to help transform the physical exam and todayâ€™s announcement reaffirms GE Healthcareâ€™s commitment to research and improving patient care by helping enhance the physicianâ€™s ability to quickly and accurately diagnose patients.â€
Many of our lectures reference the same pantheon of literature on ultrasound in the acutely hypotensive patient. For ease of reference here they are, with appropriate links to the original publications:
Sinai’s own Dr. Lana Friedman, Pediatric Emergency Medicine Fellow, was just named one of three recipients of the prestigious SPR Fellow Clinical Research Award. Her abstract entitled, â€œAccuracy of Point-of-Care Ultrasound (PoCUS) by Novice Pediatric Emergency Sonologists in the Diagnosis of Skull Fractures,â€ was selected from a very competitive pool of submissions. She will present the abstract at the PAS meeting in Denver in April.
Congratulations to Dr. Friedman and her research advisor, Dr. Jim Tsung!
On November 17, 2011 Dr. Braden Hexom presented research organized by Mount Sinai and conducted at JFK Hospital in Liberia. The project,
Evaluation of Novel Obstetrics Ultrasound Curriculum for Local Healthcare Providers in Liberia
Bentley S, Hexom B, Nelson BP
described a novel ultrasound curriculum developed in concert with providers in Liberia after a needs assessment and analysis of various use models of ultrasound deployment in the area.
It was determined that among the highest-yield applications of point-of-care ultrasound was pregnancy evaluation, especially during the third trimester. According to the United Nations Population Fund, Liberia’s rate of maternal mortality is among the highest in sub-Saharan Africa (994 per 100,000 live births). Increasingly international organizations such as WINFOCUS have lauded ultrasound as a means of empowering patients and providers in under-resourced areas and improving the quality of care delivered.
A great presentation by Alberta Spreafico (Outreach and International Development Program Coordinator at Henry Ford Health Systems) highlights this topic in an eloquent and inspiring fashion. See below for her TED talk!
On September 28 Dr. Suzanne Bentley presented the abstract:
Ultrasound evaluation for appendicitis in children: Can we safely reduce CT scan utilization?
Bentley S, Nelson BP, Zahn L
at ACEP in Las Vegas. Data on using ultrasound as a first-line diagnostic modality (instead of CT scan) were discussed, with implications for diagnostic accuracy, radiation exposure, and length of stay. This was abstract #001, which carries no more prestige than #998 but we will be proud anyway.
A great deal of attention has recently focused on radiation exposure risks, and many organizations have allied to reduce necessary imaging. The Image Gently Alliance for example boasts dozens of member organizations and has done a great deal to educate providers about the risks of ionizing radiation in imaging. A brief article on the study was published by Reuters Health:
For pediatric appendicitis, ultrasound cuts radiation, saves time over CAT scans (subscription only)
Emergency Medicine has advocated the use of ultrasound for quite some time. As point-of-care ultrasound as well as radiology department ultrasound gain ground we hope to make informed diagnostic decisions while minimizing risks.