Training guidelines for ultrasound: worldwide trends

doi:10.1016/j.bpa.2009.08.001

Best Practice & Research Clinical Anaesthesiology

Volume 23, Issue 3, September 2009, Pages 363-373

https://doi.org/10.1016/j.bpa.2009.08.001 Get rights and content

Sound travels through objects that block light. Only very recently has technology advanced enough to decipher ultrasound for medical use. Machines have become smaller, cheaper, more versatile and more advanced than ever before. The medical use of ultrasound spreads across many fields so that traditional areas no longer have a monopoly. With this comes the question of training doctors. This has been done by various colleges and societies worldwide. Some have been quicker to act than others. There also needs to be an understanding of when broad experience and advanced technical skills are required or when limited skills will do. In addition, some procedures can be performed more safely with ultrasound where the knowledge of ultrasound is not paramount. This article covers current provision of training in echocardiography and ultrasound in areas relevant to anaesthetists who are working in critical care (including accident and emergency) and complex surgery (mainly cardiac).

Section snippets

Evolution of training in ultrasound

The ancient Greeks used a weighted rope to perform ‘sounding’ to measure the depth of water. The 17th century scientist Robert Hooke noticed that sounds could be heard from the human body and suggested that if we could visualise these sounds we could build up a picture of what lies inside. These were concepts of distance and shape of objects. The first use of sound to detect objects was in military applications of ‘A-mode’ scanning to detect submarines after World War I.

Piezoelectric materials

Horses for courses

Ultrasound has shown itself to be useful in a wide variety of settings and traditional, long, course knowledge training is not appropriate in all settings. The philosophy is different. In cardiology a complete understanding of cardiac disease is the primary position and then an awareness of where echocardiography assists in diagnosis and follow-up of the disease. To get the most out of the ultrasound means that all its modalities need to be understood and used regularly. However, just being a

Knowledge-based versus caseload training

Knowledge without experience is no more useful than experience without knowledge. Both are required, and this follows on from the discussion in the above section and that of the procedural and diagnostic training in ultrasound scanning. Cardiologists felt threatened when cardiac anaesthetists began gaining proficiency in TOE. They felt that their special skill could not just be passed onto anaesthetists, that this is not an anaesthetic territory and felt it even harder to accept that some

Certification and accreditation

Certification is a statement (often on a piece of paper) of a fact (e.g., ‘This is to certify that Dr Smith completed 15 hours of training in ultrasound.’) while accreditation is an official recognition. To be accredited is to be ‘generally accepted, having guaranteed quality.’ Thus the body or society that awards the ‘accreditation’ is giving a seal of approval of a certain standard for which the society itself is a recognised authority. This is very important for public confidence. It serves

Future trends

The expanding use and application of ultrasound will continue, with further reduction in the size and cost of the equipment and technology, which will make ultrasound more user-friendly and intuitive. Matrix scanners and 3-D or 4-D imaging are a reality. It will be as common to see a physician including ultrasound whilst assessing a patient, as it is now to see a stethoscope. In addition, a much wider range of procedures will be ultrasound guided. Medicine advances in some general directions,

Conflict of interest

The author has no conflict of interest either financial or personal that may have affected the content of this article.

References (27)

T. Ryan et al.
Task force 4. Training in echocardiography
Journal of the American College of Cardiology
(2008)
P.S. Douglas et al.
Appropriateness criteria for transthoracic and transoesophageal echocardiography
Journal of the American College of Cardiology
(2007)
S.J. Capper et al.
Transoesophageal echocardiography for the detection and quantification of pleural fluid in cardiac surgical patients
British Journal of Anaesthesia
(2007)
W.J. Stewart et al.
Echocardiography in emergency medicine: a policy statement by the American Society of Echocardiography and the American College of Cardiology
Journal of the American Society of Echocardiography
(1999)
J. Mateer et al.
Model curriculum for physician training emergency ultrasonography
Annals of Emergency Medicine
(1994)
A. Bodenham
Ultrasound imaging by anaesthetists: training and accreditation issues
British Journal of Anaesthesia
(2006)
S. Harvey et al.
Assessment of the clinical effectiveness of the pulmonary artery catheter; a randomised controlled trial
Lancet
(2005)
The task force for transoesophageal echocardiography. Practice guidelines for perioperative transoesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists
Anesthesiology
(1996)
M.K. Cahalan et al.
American Society of Echocardiography and Society of Cardiovascular Anesthesiology Task Force guidelines for training in perioperative echocardiography
Anesthesia and Analgesia
(2002)

Training in diagnostic ultrasound: essentials, principles and standards. Report of WHO study group. Technical Report...

A.S. Pearlmann et al.

Guidelines for optimal Physician training in echocardiography. Recommendations of American Society Echocardiography committee for physician training in echocardiography

The American Journal of Cardiology

(1987)

M.A. Quinones et al.

ACC/AHA clinical competence statement on echocardiography

Journal of the American College of Cardiology

(2003)

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Transthoracic echocardiography (TTE) is a powerful non-invasive diagnostic, monitoring and measurement device in medicine. In addition to cardiologists, many other specialised groups, including emergency and critical care physicians and cardiac anaesthetists, have recognised its ability to provide high quality information and utilise TTE in the care of their patients. In obstetric anaesthesia and management of obstetric critical illness, the favourable characteristics of pregnant women facilitate TTE examination. These include anterior and left lateral displacement of the heart, frequent employment of the left lateral tilted position to avoid aortocaval compression, spontaneous ventilation and wide acceptance of ultrasound technology by women. Of relevance to obstetric anaesthetists is that maternal morbidity and mortality due to cardiovascular disease is significant worldwide. This makes TTE an appropriate, important and applicable device in pregnant women. Clinician-performed TTE enables differentiation between the life-threatening causes of hypotension. In the critically ill woman this improves diagnostic accuracy and allows treatment interventions to be instituted and monitored at the point of patient care. This article outlines the application of TTE in the specialty of obstetric anaesthesia and in the management of obstetric critical illness. It describes the importance of TTE education, quality assurance and outcome recording. It also discusses how barriers to the routine implementation of TTE in obstetric anaesthesia and management of obstetric critical illness can be overcome.
Solid, Cystic, and Tubular: Novice Ultrasound Skills Training Using a Versatile, Affordable Practice Model
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As a quick and inexpensive tool, ultrasound provides physicians a noninvasive method of looking into the body without exposing patients to radiation. Today, the use of ultrasound image-guided procedures is becoming more widespread and is considered the gold standard in some clinical settings.3 In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures.
In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model.
Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate.
The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI.
The model was tested in a cohort of 50 medical students and general surgery residents.
The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents.
This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence.
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11Training guidelines for ultrasound: worldwide trends

Section snippets

Evolution of training in ultrasound

Horses for courses

Knowledge-based versus caseload training

Certification and accreditation

Future trends

Conflict of interest

Journal of the American College of Cardiology

Journal of the American College of Cardiology

British Journal of Anaesthesia

Journal of the American Society of Echocardiography

Annals of Emergency Medicine

British Journal of Anaesthesia

Lancet

The task force for transoesophageal echocardiography. Practice guidelines for perioperative transoesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists

Anesthesiology

American Society of Echocardiography and Society of Cardiovascular Anesthesiology Task Force guidelines for training in perioperative echocardiography

Anesthesia and Analgesia

Guidelines for optimal Physician training in echocardiography. Recommendations of American Society Echocardiography committee for physician training in echocardiography

The American Journal of Cardiology

ACC/AHA clinical competence statement on echocardiography

Journal of the American College of Cardiology

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Training guidelines for ultrasound: worldwide trends