Life Hacks for the 2018 AIUM Annual Convention

Plan
View the full program online and, to keep on top of all things #AIUM18, download the eventScribe app now from the Apple store or Google Play store and search for AIUM 2018. imageBefore and during the convention, use the app to plan your schedule, read about sessions, take notes, learn about exhibitors, and engage with other attendees.

Learn all about the app by checking out these videos on using the app: Quick Navigation Guide, Browsing Style, Taking and Sending Notes, E-mailed Notes, Messages, and Events.

Go
Travel to the convention via plane, train, or automobile. The hotel, New York Hilton Midtown, is located on Avenue of the Americas (6th Ave) between West 53rd and West 54th Streets. To get to the hotel from 1 of the 3 nearby airports, or Grand Central station, Penn Station, or Port Authority, which are all within approximately 20 minutes of the hotel, you can take a taxi or rideshare service. To get around the city, walk or take the subway, a taxi, or a rideshare.

 

Follow
Stay in the know by following the AIUM and the Convention on Twitter (#AIUM18), Instagram (AIUMultrasound), vimeo, LinkedIn, and Facebook as we share news and events, as well as photos and videos.

Learn and Network

  • Two preconvention postgraduate courses will be offered on Saturday, March 24. Additional fees apply.
  • We doubled the number of hands-on Learning Labs. Our Learning Labs provide an up-close and personal learning experience while earning CME credit.
  • Learn from leading ultrasound experts in small group settings in Meet-the-Professor sessions. There are a dozen Meet-the-Professor events to choose from. Each comes with lunch. Separate registration fee is required. If you haven’t registered, act quickly because more than half the sessions are sold out.
  • The AIUM has added 2 networking receptions to the Convention schedule. Plan to meet up with colleagues, explore the latest technology, and ask questions you may have during these cocktail and hors d’oeuvre events on the Exhibit Hall floor.
  • The AIUM received a record number of research abstracts for the 2018 AIUM Convention. This research will be shared by AIUM’s new investigators, abstract presenters, and e-poster submitters throughout the event.
  • Community and Interest Group Meetings: Meet with other ultrasound professionals who share your interests, plan future AIUM educational programs, and discuss the issues in your specialty.

 

Exercise
Start your day off with some exercise: join your colleagues and AIUM staff each morning from 6:30–7:15 am for a 3-mile run/walk around New York City’s Central Park. You’ll meet up in the Main Lobby at 6:30.

Hunt
Join the Scavenger Hunt at the convention: download the eventScribe app (search AIUM18) to get started on your chance to win one of several prizes that will be awarded upon completion of the game. A grand prize winner will be announced Tuesday afternoon.

Earn

CME      Earn up to 6.5 CME credits during the Preconvention and 29.5 CME credits during the Convention.

ARRT    Earn up to 6.5 ARRT credits during the Preconvention and 29.5 ARRT credits during the Convention.

SAMs     The American Board of Radiology (ABR) has approved 7 Self-Assessment Modules (SAMs) activities from our upcoming 2018 Convention.

UGRA    One session at the Preconvention and 8 sessions at the Convention have been added to the UGRA Portfolio program’s course offerings.

Please note that although the AIUM provides CME certificates to those who have participated in an AIUM educational activity, the AIUM does not submit credits to regulating bodies or certifying organizations on behalf of the participant. It is the participant’s responsibility to submit proof of credits on his or her own behalf.

Explore

Lid5nyGET

When you’re not attending the convention, check out some of what New York has to offer. Here is a short list of just a small portion of what is out there, including museums, parks, iconic buildings, and more. And, don’t forget to check out minus5° in the hotel’s lobby, where everything in the bar is made of ice, including the glasses.

The Expeditious Evolution of Emergency Ultrasound Fellowships

RJG Photo 2

Access to the internet was dial up through AOL, Bill Clinton was President, and ultrasound machines were big, clunky, and new to the emergency department. It was 1999 and I was in Long Island as a resident. As a resident, I saw the ultrasound machine lurking around the emergency department, but very few faculty seemed to know how to use it. A search of fellowships in emergency ultrasound found a single listed fellowship in Chicago, so I organized a rotation to see what ultrasound was all about.

Emergency ultrasound fellowships in the early 2000s were disconnected, isolated, and in many ways under the radar. As the ultrasound interest group president in SAEM (soon to become the Academy of Emergency Ultrasound) I heard firsthand how difficult it was for fellows to find ultrasound fellowships and how difficult it was for fellowship directors to find applicants. Partnered with Pat Hunt, we started EUSFellowships.com as a platform for fellows and programs to meet. Ultrasound became more mainstream as ACEP, SAEM, and CORD fought to have ultrasound integrated into residency training and general emergency medicine.

Eventually EUSFellowships.com evolved into the Society of Clinical Ultrasound Fellowships as a more robust organization focused on advanced training for bedside ultrasound. The first couple of emergency ultrasound fellowships started around 1997. Within 5 years there were 12 fellowships, and within 10 years there were 27. Today there are over 100 emergency ultrasound fellowships graduating more than 70 fellows each year. There are more ultrasound fellows graduating each year than in toxicology and EMS combined.

Emergency ultrasound fellows today join a large vibrant group of specialists across the United States and the world. Physicians use ultrasound to diagnose, monitor, and guide procedures everywhere from the African savannah to the neighborhoods in New York City. The initial meetings in the 1990s involved small groups getting together to discuss cutting-edge research and new applications. Now ultrasound meetings in emergency medicine involve hundreds of people discussing topics such as board certification or ultrasound program management. Research has evolved from single “we can do it too” projects to multi-center collaboratives. The change in ultrasound over the last 20 years is mind blowing.

When I interview medical students now, I ask them why they went into medicine. What do they want to achieve? One of the best answers I hear is that they want to make a difference in medicine and improve care for all patients. I feel that I have been lucky enough to witness the birth of a new subspecialty that will improve how patients are cared for in the future.

 

What was your initial experience with ultrasound education? Where did you learn your ultrasound skills? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Romolo Gaspari, MSc, MD, PhD, FACEP, is the Executive Vice Chairman of the Department of Emergency Medicine at UMASS Memorial Medical Center. He has also served as the president of a number of Emergency Ultrasound Societies including what is now the Academy of Emergency Ultrasound and the Society of Clinical Ultrasound Fellowships.

Flying Samaritans, the Seed to Pediatric Point-of-Care Ultrasound

There are some experiences in life that seem to have a tremendous impact on the person you become, and the career path you decide to take. When I started working with the Flying Samaritans in medical school, little did I know that it would change the trajectory of my career.

Kids from El Testerazo Mexico

The kids I fell in love with in El Testerazo, holding the pictures I had taken and shared with them. They came by even if they weren’t sick. Of note, they are now in their 20s with families of their own.

Since the UC Irvine School of Medicine was so close to the USA-Mexico border, the UC Irvine Flying Samaritans chapter was actually a driving chapter. Each month we drove down to El Testerazo, Mexico, to give medical care and medications to an underserved community. I immediately fell in love with the community and the children of El Testerazo, Mexico. They would all laugh at my then broken high school-level Spanish, but would appreciate my trying. There was also something about the group of undergraduates (who ran the clinic), medical students, residents, and attending physicians who volunteered their time there that brought back the humanity to medicine. The experience was challenging and rewarding at the same time—to work with limited resources, but to become a trusted member of their community was priceless. Each time I went to the “Flying Sams” clinic, I remembered why I went into medicine in the first place.

During my time with the “Flying Sams,” I worked with a then Emergency Medicine resident, Chris Fox. When he told me he was going to Chicago to do a 1-year Emergency Ultrasound fellowship, I thought he was crazy.

Old ultrasound machine

The ancient beast of an ultrasound machine that we had in the “Flying Sams” clinic.

Not only was he leaving sunny Southern California, but he was going to spend a year looking at ultrasounds? When I looked at ultrasounds, I could barely make out structures; images looked like the old tube TV’s from the 1980s. When Fox returned, he said, “Steph, the next big thing will be pediatric ultrasound.” Again, I thought he was crazy. But slowly, by seeing how ultrasound impacted the management of our patients in El Testerazo, I realized the brilliance in this craziness. Chris Fox’s enthusiasm and “sonoevangelism” was infectious. I think nearly everyone in the “Flying Sams” ended up eventually doing an ultrasound fellowship. Even though the ultrasound machine in the clinic was old, and images were of limited quality, we were still able to impact the medical care of this community that became near and dear to my heart.

And so it began…my passion for emergency ultrasound (now referred to as point-of-care ultrasound) and for Global Health. My initial goal was to become good at performing ultrasounds. As I quickly realized, I was one of the only people who had experience in pediatric point-of-care ultrasound. I felt a tremendous responsibility to become as knowledgeable and skilled as possible, if I were going to teach others this powerful tool. After 4 years of undergraduate education, 4 years of medical school, 3 years of a Pediatrics residency, and 3 years of a Pediatric Emergency Medicine fellowship, I decided to do an additional 1-year fellowship in Emergency Ultrasound. With medical school loans looming and so many years without a “real job,” I was reluctant to do this. This California girl moved from sunny Southern California, to Manhattan to embark on a 1-year Emergency Ultrasound fellowship. This was a move far outside of my comfort zone for so many reasons. And that was one of the reasons why it ended up being one of the best decisions I’ve ever made. It has been a privilege to be a part of this growing community… to take better care of the most vulnerable of patients… and to give this tool to other doctors around the world. I certainly would have never had these experiences or opportunities if it weren’t for the “Flying Sams” and Chris Fox; to both I am forever grateful.

 

 Are you involved in global medical education? If so, what led to your decision to go into the field? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Stephanie J. Doniger, MD, RDMS, FAAP, FACEP is the Editor of the first pediatric point-of-care ultrasound textbook “Pediatric Emergency and Critical Care Ultrasound,” and is currently practicing Pediatric Emergency Medicine and Point-of-Care Ultrasound in New York. She has additional training in Tropical Medicine and is in charge of Pediatric POCUS education for WINFOCUS Latinamerica.

To My Fellow Sonographers

Dear fellow sonographers,

I am proud to say that I have worked as a sonographer since 1983 and have been on an incredible journey for 34 years. I started out at the Washington Hospital Center in Washington, DC, as a radiologic technologist and had the privilege to work on the job as a sonographer. I have evolved, grown, and through my profession I have continued to educate myself. When I passed the ARDMS certification in 1984, I decided that I would continue to set goals for myself and keep my career in ultrasound exciting and challenging.

Over the next 33 years, I worked in a Radiology office, in private practice, and in maternal fetal medicine. Now, I am honored to be part of the American Institute of Ultrasound (AIUM). So, why am I saying all this? Because I now want to encourage all of you to use my experiences to take your profession to the next level.

My personal goal is to educate sonographers. To encourage sonographers to love their jobs and be the best. Times have changed, especially in the ultrasound world. Doing an OB exam and showing only a 4-chamber heart is no longer enough. Now, we are expected to do outflow tracts, aorta, ductus, and sometimes the infamous 3-vessel trachea view.

If you are asking what is the 3-vessel trachea view? Well, let me just tell you about this amazing cardiac image. If you can acquire and document a normal 3-vessel trachea you can rule out Transposition of the Great Arteries (TGA), Tetralogy of Fallot (TOF), and Right-sided Aortic Arch. You can also be the hero of the office when you go to your doctor at your practice and say “Hey, the 3-vessel trachea view looks abnormal, what do you think?” Not only will you impress them and possibly save a life, but you will earn respect and, hopefully, you are reminded as to why you wanted to be a sonographer in the first place.

I have always loved my job and continue to learn every day. There is a whole world of ultrasound information out there. I challenge you to go beyond what you know to get the job done, be the best, and always treat your patient as your best friend, whoever that might be. My challenge for you is to read about the 3-vessel trachea view and, if it is not a part of your daily OB routine, add it.

Please join me and expand your education!

Haylea Weiss, RDMS (AB FE OB/GYN)
American Institute of Ultrasound in Medicine

Apply for AIUM’s new Sonographer Scholarship Grant, a program that provides $500 and free registration to an AIUM post-graduate event. Applications due March 1.

Ultrasound-Guided Musculoskeletal Injections

I began using Musculoskeletal (MSK) ultrasound (US) in 2010. It has been incredibly exciting to observe to growth of applications of this amazing technology for both myself personally as well as for the entire MSK US practicing community. MSK US has become an integral part of my Sports Medicine practice and I certainly anticipate its’ role to continue to expand and be able to provide cutting edge medical care to my patients.IMG_8265

There is great variability with which MSK US is used among practitioners. Some providers do complete diagnostic scans of the shoulder for example, to evaluate the extent of a potential rotator cuff tear to guide with potential surgical decision making, while others perform selective nerve blocks and finally some practitioners simply use it to assist with the accuracy of various MSK joint and soft tissue injections. I would like to illustrate to all of you the applications for which I most commonly use MSK US to improve patient care.

Probably the most common application for which I use MSK US is to assist with the accuracy of joint and soft tissue injections. It has been clearly documented that MSK US improves the accuracy of certain MSK injections. While I do not use MSK US for all injections, ie, simple knee intra-articular and shoulder sub-acromial injection, I routinely employ MSK US to assist with certain injections. Common joints and soft tissue areas for which I employ MSK US for either cortisone or pro-inflammatory injections like Platelet Rich Plasma (PRP) are:

Shoulder: Glenohumeral and acromioclavicular joint and long head biceps tendon sheath

Hip: Femoroacetabular, hamstring origin (tendon or bursa), mid portion hamstring, pubic symphysis, gluteal tendons and bursa, iliopsoas bursa and tendon

Knee: Pes anserine and iliotibial bursae, patella and quadriceps tendons, Baker’s cyst aspiration

Wrist: Triangular fibro cartilage complex (TFCC), various wrist extensor and flexor tendons, aspirate ganglion cysts, numerous hand and wrist joints

Elbow: Lateral and medial epicondyle area, triceps insertion, olecranon bursitis, distal biceps and intra articular

Ankle: Achilles, tibialis posterior, peroneal tendons, numerous foot and ankle joints, plantar fascia

Back: Sacroiliac joint

I would also like to illustrate some interesting recent cases supporting the utility of MSK US in a Sports Medicine practice.

I am consulted numerous times a week by my orthopedic surgeon colleagues for diagnostic joint injections. Oftentimes, a patient’s hip pain may be multifactorial or difficult to specifically isolate. I will perform an intra-articular injection to see if it alleviates that patient’s pain, thus identifying that the area in which I placed the injection as the pain generating location. Correct identification of the pain generating source will help to assist with treatment considerations.

I also recently had a patient with greater than 1 year of hip pain. He had seen 8 different providers and had an extensive work up with imaging and injections only to have continued pain. He had hip joint and hamstring origin injections and felt no improvement. I was able to use the US to identify and isolate the obturator internus as the source of his pain by providing a diagnostic injection. This injection helped to make the appropriate diagnosis and ultimately influenced treatment.

Last month, an orthopedic surgeon asked me to evaluate a patient for refractory symptoms from a Baker’s cyst. The cyst persisted despite multiple intra articular-injections. I evaluated the cyst with US and noted that it was multilobulated. I was able to specifically aspirate each of the loculations and the patient has remained symptom free.

I was also asked to see one of our varsity basketball players for refractory lateral knee pain. His athletic trainer was treating him with rehabilitation and multiple modalities but the pain persisted and was affecting the athletes’ ability to play. I was able to identify an inflamed Iliotibial band bursa with the US and subsequently inject it. He became pain free and was able to play in that weeks’ game as well as the rest of the season.

Another exciting application of MSK US that has piqued my interest recently is the use of the US to assist with appropriately identifying the compartments of the lower extremity for chronic exertional compartment testing. I can employ the US to guarantee that I am in the appropriate anatomic compartment for testing.

With any new technology, the application and utility of MSK US can be user-dependent and it can be affected by a somewhat steep learning curve. MSK US curriculums are frequently being added to Sports Medicine fellowships to train some of the future leaders of medicine. I certainly anticipate that this technology with continue to evolve and its’ treatment applications will continue to expand.

 

How do you use MSK US? How has it improved your practice? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Bryant Walrod, MD, CAQSM, is Assistant Professor: Clinical at Ohio State University, is Team Physician for the Ohio State Athletics, and practices at The Ohio State University Wexner Medical Center.

Interest in Interest Groups

Ultrasound in medical education is a powerful idea whose time has come. With its value in the clinical setting being increasingly recognized, leaders of a point-of-care ultrasound (POCUS) movement are making a strong case for introducing ultrasound early in medical training. Not only is it a useful educational tool to illustrate living anatomy and physiology, but it is also an important clinical skill- guiding procedure, improving diagnostic accuracy, and facilitating radiation-free disease monitoring. As the list of POCUS applications grows exponentially across specialties, I believe that to maximize the potential impact, it is vital to introduce this skillset early during the pleuripotent stem cell phase of a young doctor’s career.

Wagner

Looking around, there are signs this movement is here to stay. Ten years after the first medical schools began integrating ultrasound into the curriculum, an AAMC report of US and Canadian schools stated that at least 101 offered some form of ultrasound education, with the majority including it into the first 2 years of the curriculum. If one visits the AIUM medical education portal (http://meded.aium.org/home), 77 medical schools list a faculty contact person involved with ultrasound curriculum development and integration.

It should be noted that the depth of content varies from school to school, as not all institutions value ultrasound to the same degree. Recommendations on core clinical ultrasound milestones for medical students have been published and results from a forthcoming international consensus conference will help improve standardization, though there will likely be much variability until it is required by LCME or included on board exams.

It is during this time of transition that the importance of ultrasound interest groups (USIGs) cannot be understated. USIGs provide a wider degree of flexibility often not possible within a formal curriculum, quickly adapting for changes not only for meeting times and group sizes but also topics and teaching strategies. Indeed, for schools without a formal ultrasound curriculum it is often how one gets started. For ultrasound faculty, USIGs provide fertile ground for experimenting with new teaching ideas and cultivating both student and faculty enthusiasm for POCUS at one’s institution. For senior students, USIGs can provide opportunities to participate in research projects, serve as near-peer instructors, and participate at regional and international meetings. The spread of local, student-run Ultrafest symposiums is a testament to the power ultrasound has to draw people in and the impact students can have beyond their own institution. The AIUM National USIG (http://www.nationalusig.com/) provides a nice resource for further collaboration while student competitions like AIUM’s Sonoslam or SUSME’s Ultrasound World Cup showcase ultrasound talent and teamwork in an anti-burnout, fun environment. I have no doubt that some of these exceptionally motivated students will become future leaders in the field, as some already have (http://www.sonomojo.org/).

While many of these students will pursue and jumpstart their careers in Emergency and Critical Care Medicine, students from varying backgrounds and interests are needed in USIGs. The frontier of Primary Care ultrasound is wide open and may become crucial as we see more emphasis on population medicine and cost containment as opposed to fee-for-service models. With the exception of in the ER, the utilization of pediatric ultrasound has been surprisingly lagging and more POCUS champions are certainly needed here. In addition, the early exposure to POCUS can increase comfort with ultrasound and help drive novel developments by future specialists. Some lesser known potential examples include advancing work already underway: gastric ultrasound for aspiration risk by anesthesiologists, sinusitis and tonsillar abscess drainage for ENTs, diagnosing and setting fractures for orthopedists, noninvasively measuring intracranial pressure by ophthalmologists and neurologists, and detecting melanoma metastasis by dermatologists. Until it is more widespread, a skillset in POCUS can be a helpful way to distinguish oneself in an application process and provides an excellent academic niche. After medical school, some USIG students will go on to form ultrasound interest groups in their specialty organizations, going beyond carving out a special area of interest for themselves and helping to advance the field and shape future policies.

Similar to other enriching things like viewing art and discussing philosophy, I believe all students should be exposed to ultrasound and given the opportunity to learn this skill. While I feel strongly that ultrasound should be a mandatory component of an undergraduate curriculum, I also recognize that not all will enjoy and excel in it, and many will settle for nothing more than the bare minimum. However, I believe the USIGs help us to motivate and empower those few individuals with the passion and grit to really help propel this movement forward and show the world what is possible. This is truly an exciting time. I hope you will join us.

Ultrafest

Are you a member of an ultrasound interest group? Has it improved your skill set? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Michael Wagner, MD, FACP, RDMS, is an Assistant Professor of Medicine at the University of South Carolina School of Medicine in Columbia. There he serves as the Director of Internal Medicine Ultrasound Education for the residency program, Assistant Director of Physical Diagnosis for the undergraduate curriculum, and faculty advisor to the student ultrasound interest group. You can view his 2017 talk for the USCSOM USIG here (https://youtu.be/FfO7SXRwjLY) and an AIUM webinar with Janice Boughton on a pocket ultrasound physical exam here (https://www.youtube.com/watch?v=ywuIeoEfG1I).

 

If ultrasound was a…

Let’s not beat about the bush; I absolutely love ultrasound. Ever since I picked up some rudimentary ultrasound device to measure bladder volumes when working as an intern on a spinal injuries unit in England, I was hooked. The ability to cast an acoustic eye within someone’s body still continues to impress me 20 years later and ultrasound continues to amaze, thrill and impress me with its understated power and image generating magic.

However, as time passes, I have begun thinking more and more about ultrasound in a different way. What is its ‘style,’ its ‘look’ and its ‘feel’; in essence, what is its ‘personality.’ If it had an emoji, what would it be? How would you describe how ultrasound makes you feel and what images does it conjure up in your mind’s eye? To take this a step further, I have begun toying with the idea of what ultrasound would be if it was something else entirely. To explain what I mean, humor me as you read this blog which gives me the opportunity to explain how I have started to see ultrasound’s ‘personality’ in many different guises….

If Ultrasound was painter, it would be…

Georgia O’Keefe. Georgia O’Keefe was a radical painter who generated many beautiful images during her life in the early 1900s. She is most famous for her vivid depictions of the New Mexico desert when she lived at her evocatively named ‘Ghost Ranch’ in the middle of the wilderness. Before that, she worked in New York and produced some exquisite images of plants and flowers. My favorite is ‘Abstraction White Rose’ pictured below – and as a pediatric radiologist you can see why…

OKeefe

© 2017 Georgia O’Keeffe Museum / Artists Rights Society (ARS), New York

If Ultrasound was a country, it would be…

Sweden. Sweden as a country strikes me as being somewhere rather monochromatic but also somewhere extremely beautiful once the snows clear. This always reminds me of that sinking feeling we all had when learning ultrasound as a trainee. While struggling to generate something vaguely resembling an organ, all one could see was snow. Snow, snow and more snow. Then, without any tweaking of knobs or any change of probe, your teacher would take the transducer from your hand, place it on the patient and generate the most exquisite image. The blizzard clears and a beautiful landscape is revealed.

US and snow

If Ultrasound was an animal, it would be…

A bee. The frenetic to-ings and fro-ings of the portable ultrasound list is exhausting, varied, challenging but also somewhat satisfying. The uniqueness of ultrasound as a tool that can be taken anywhere in the hospital is one of its finest attributes. Like the bumble bee, it flits from patient flower to patient flower gathering the information it needs like pollen, before returning back to the hive for the Queen to marvel as its conquests. I can almost hear the buzzing.

Bee

If Ultrasound was a drink, it would be…

A hot Italian latte. Have you ever drunk an Italian latte in a glass and noticed the differing layers of coffee and milk? Doesn’t that remind you of something? If not, you need to do more lung ultrasound.

Seashore and latte

So, what about you? Do you have any favorite ‘if ultrasound was a <blank>, it would be a…’ thoughts? We’d love to hear your favorite connotations and understand how ultrasound resonates (ha – geddit?) with you. Comment below or let us know on Twitter: @AIUM_Ultrasound.

Rob Goodman, MB, BChir, is Professor and Acting Chair of the Department of Radiology & Biomedical Imaging at Yale University School of Medicine in New Haven, Connecticut.