Women in Ultrasound Leadership: Seeing the Future

At first, I was excited for the opportunity to write a piece for The Scan on Women in Ultrasound Leadership. I love ultrasound and I love trying to advocate for women in medicine, especially women in medicine leadership. Sounds great, right? Then my efforts quickly became like the purgatory on a page of my personal statement for internal medicine residency application. Next came a hard-core resurgence of the “Impostor Syndrome” I’ve been working pretty hard to quell, with the support of some great colleagues and friends. In case you’re one of the few people who have never experienced this, Impostor Syndrome is defined by Dr Google as “the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills.” So, how do you write for yourself and try to encourage others to keep waging and winning these internal AND external battles? Especially when you so very acutely remember all those doubts (and *may* have had to take propranolol for near panic over giving a Meet the Professor session on POCUS at the American College of Physicians convention last year)?! Here’s how: You look at the numbers, get fired up, think about yourself in the past—plus all of the other women out there—and get down to it.Renee

Since you’re probably wondering who in the heck I am, and why I am qualified to write about women in ultrasound leadership, let me introduce myself. I am a lifelong Oregonian outside of 3 years in Boston at Massachusetts General Hospital for my internal medicine residency. During my residency, I fell in love, first with simulation as an educational method, and later with point-of-care ultrasound (POCUS). I felt these methods could do so much to advance the care of medical patients beyond the ED, where POCUS was most common. Then, I returned home to my first attending role in the Division of Hospital Medicine at Oregon Health & Science University (OHSU). My passion for ultrasound developed further as I learned additional clinical uses and saw just how much you could use ultrasound to teach residents and students in the foundational sciences and beyond.

With the knowledge, support, and sponsorship of my former provost, Dr Jeanette Mladenovic, I started my ultrasound leadership journey. My first experience with the incredibly welcoming national POCUS community was when the World Congress of Ultrasound in Medical Education came to OHSU in October of 2014. With Dr Mladenovic’s encouragement, I helped out with logistics, including scheduling and faculty, room, and machine assignments, and did a bit of teaching. But mostly I fan-girled over my POCUS heroes, learned, and connected. There were probably only 10–15 other internists that year, but I was so inspired by their work and the POCUS community in general that I will forever fondly remember that meeting.

Since then, via connections, friends, mentors, and sponsors made at that meeting, I have been able to teach at national internal medicine (IM) pre-courses, give lectures, webinars, and podcasts, and create and deliver local, regional, and national/international POCUS curricula at OHSU, including for the AIUM (where I now also serve on the Board of Governors).

It’s been a wild ride, and I’d like to take a quick pause to define and highlight the concept of sponsorship, and what it has done for me. “The Real Benefit of Finding a Sponsor” in Harvard Business Review (HBR) asserted:

“The Sponsor Effect” defines a sponsor as someone who uses chips on his or her protégé’s behalf and advocates for his or her next promotion as well as doing at least two of the following: expanding the perception of what the protégé can do; making connections to senior leaders; promoting his or her visibility; opening up career opportunities; offering advice on appearance and executive presence; making connections outside the company; and giving advice. Mentors proffer friendly advice. Sponsors pull you up to the next level.

Another HBR piece I love highlights the importance of women supporting each other, instead of responding to inequality in the workplace by holding down other women. The article describes sponsorship as “connecting a protégé with opportunities and contacts and advocating on their behalf, as opposed to the more advice-focused role of mentorship.”

Setting aside the actual promotion piece of sponsorship (given the rather structured, CV-driven nature of the academic promotion process) in my mind really drills down to someone with influence going above and beyond suggesting high-yield activities and relationships for a mentee. Instead, a sponsor makes those connections for them, putting their name up there for that national committee, speaking role, suggesting them for that multi-site study, etc.

So why am I telling you all this? Because we NEED TO ACT. Across the spectrum, there are profound discrepancies between the two sexes: woman are paid less, promoted less, funded less, published less, and finally, invited to speak & peer review less (https://www.bmj.com/content/363/bmj.k5232).

I want to acknowledge that both men and women in the POCUS and ultrasound communities have supported me, but we all have more to do. The ultrasound community is not immune to the “manel.”

“Conceptually, the reason why a panel would be organized in the first place, whether at a conference, on cable news, or as part of a legislative session, is to ensure a diversity of opinions and perspectives are brought to the issue up for discussion…The term manel has, like its predecessors, become a useful way to take note of a circumstance in which men may not realize that something they’re involved in has the effect of marginalizing women.”

Once we acknowledge that there is gender inequality, we can all play an active role in addressing it. Here are a few places to start:

  • Don’t wait for women to come to you. Step up and volunteer to be a sponsor without being asked.
  • Nominate a female colleague for an award.
  • If you find yourself on a planning committee, make sure speaker suggestions include women as well.
  • Be fair in your authorship, and make sure if you suggest peer reviewers you suggest women and In fact, being inclusive of women can translate to all aspects of your life!

Finally, my message to junior female colleagues: Focus on your strengths and what you have to give. Don’t be like me and be petrified by your lack of formal training, supplemental degrees or certificates, being the only woman or internist or sonographer in the room. No one knows everything. Own what you don’t, be honest, and do NOT let obsession with limitations or perfection be the enemy of good. Take it from me. And if you don’t have one, get out there & find yourself a sponsor. Okay, actually that was my message to all female colleagues!

In closing, I am thankful for the ultrasound community and all of the opportunities I have had to contribute to the AIUM mission and ultrasound use in general. I am honored to be on the Board of Governors for an organization with a female CEO. I am proud to be on faculty at a university with a female Dean, Provost, Chief Medical Officer, and Assistant Dean of Undergraduate Medical Education. Finally, I am thrilled to contribute my love of POCUS as both an educational & diagnostic tool, along with my love of “gab” & connections to help promote and bring this community closer together in any way I might.

 

Do you know of a woman whose career advanced with the help of a sponsor? Have you been a sponsor? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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Renee Dversdal, MD, FACP, is Associate Professor of Medicine and Director of OHSU Point of Care Ultrasound as well as General Medicine Ultrasound Fellowship Director at Oregon Health & Science University, Portland, Oregon.

The Buzz in Orlando

From the moment you stepped foot inside the Hilton Bonnet Creek Resort, you knew this was going to be a different kind of AIUM Convention. Maybe it was the new venue. Maybe it was all the new offerings. Maybe it was the excitement about connecting and reconnecting with colleagues from around the world.IMG_7012

Whatever it was, it caused a buzz in Orlando.

If you were in Orlando, we hope you felt the same. If you were unable to make it this year, here are a few of the highlights (you can see and learn even more if you search #AIUM19 on your favorite social media site):

 

IMG_7019 copyNew Offerings—Each year, the AIUM and the Annual Convention Committee look to enhance and improve the event. This year was no exception. To get the juices flowing, attendees could participate in a morning exercise class that varied each day. We added the Recharge Lounge where attendees could relax and charge up their devices. We partnered with the International Contrast Ultrasound Society on a one-day educational event. And we enhanced the Meet-the-Professor sessions.

SonoSlam—In its fourth year, 24 teams battled it out for the coveted Peter Arger Cup. The University of Connecticut’s team, PoCUS Maximus, came out on top–and defended their title! Save the date for next year—March 21 in New York City! Big thanks to headline sponsor Canon.

 

 

Social Media—From Instagram to Twitter to Facebook, Convention attendees were very active on social media at #AIUM19. And, for the first time, there was a takeover! Kristy Le, a recent RDMS graduate, took the reigns of our social accounts to give her perspective on the AIUM Convention! Search #AIUM19 to get her take!Twitter_AIUM19

Kristys Takeover

Networking–It’s not an AIUM event if there isn’t networking. IMG_6998 copyThis year there were even more opportunities to make new contacts and reconnect with colleagues from around the world. From the morning workouts to the Presidential Reception. From Community meetings to the Welcome Reception. From the intimate Meet-the-Professor sessions to the Exhibit Hall breaks. You almost couldn’t help but expand your network.

Global Plenary—AIUM President Brian Coley, MD, hosted the Plenary session that featured a lecture on reducing workplace injuries from Kevin D. Evans, PhD, RT, RDMS, RVS, FSDMS, FAIUM, Professor at The Ohio State University College of Medicine. This talk launched a series of sessions and events at the AIUM Convention that focused on ergonomics. The entire Plenary Session is available on the AIUM Facebook Page.

Fun Activities—Not only was #AIUM19 educational, it was also fun. Buttons_IMG_1967_EDITEDThis year attendees could participate in morning exercise classes (yoga, jogging, bootcamp); do a scavenger hunt with the AIUM app (Congrats to Julie Abe, MD, from Brazil for winning the free #AIUM2020 registration); collect specialty-specific buttons (Congrats to Joanne Richards, RT, RDMS, RT on winning the smartwatch for collecting at least 15 buttons); and participate in Industry Symposia.

 

Sold-out Exhibit Hall—This year’s exhibit hall was the most exciting and active it has ever been. There were more new companies at this year’s event than ever, making the exhibit hall vibrant and exciting! IMG_7035New product releases, special offers, and cool giveaways created a buzz we haven’t seen in years. Plus, there was cake! Thanks to all the exhibitors!

Award Winners—The AIUM was proud to recognize the following award winners (look for upcoming blog posts and/or videos from some of these individuals):

James A. Zagzebski, PhD–William J Fry Memorial Lecture Award
Steven R. Goldstein, MD, FAIUM—Joseph H. Holmes Clinical Pioneer Award
Keith A. Wear, PhD, FAIUM—Joseph H. Holmes Basic Science Pioneer Award
Kevin David Evans, PhD, RT, RDMS, RVS, FAIUM—Distinguished Sonographer Award
Michael Blaivas, MD, MBA, FAIUM, FACEP—Peter H. Arger, MD Excellence in Medical Student Education Award
Bryann Bromley, MD, FAIUM—Carmine M. Valente Distinguished Service Award
Liat Gindes, MD—AIUM Honorary Fellow
Tammy Stearns, MS, RT(R), RDMS, RVT, FSDMS—AIUM Honorary Fellow

The AIUM also recognized the life and achievements of these individuals who were inducted into the Memorial Hall of Fame:

Michael L. Manco-Johnson, MD
Terry J. DuBose, MS, RDMS, FAIUM, FSDMS
Donald Baker

Up and Comers—In addition to our national awards, the AIUM also recognizes its New Investigators. This year’s winners and runners-up are:

Basic Science
Winner—Viktor Bollen, Postdoctoral Fellow, University of Chicago for “A Comparison Of Thrombus Dissolution Efficacy With Single And Multiple-Cycle Histotripsy Pulses In Vitro.
Runner-Up–Lakshmanan Sannachi, PhD, Postdoctoral Fellow, Department of Physical Sciences, Sunnybrook Health Sciences Centre for “Quantitative Ultrasound Texture-Derivative Methods Combined with Advanced Machine-Learning for Therapy Response Prediction: Method Development and Evaluation.”

Clinical Ultrasound
Winner—Misun Hwang, MD, Assistant Professor of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania for “Quantitative Detection of Brain Injury with Contrast-Enhanced Ultrasound in Neonates and Infants.”
Runner-Up–Michal Fishel Bartal, Maternal Fetal Medicine Fellow, McGovern Medical School, University of Texas at Houston (UTHealth) for “Validation of 3D Power Doppler Volume Analysis in Patients with 2D Ultrasound Suspected Morbidly Adherent Placenta.

Convention attendees say that the reason they attend this event is because of the multi-specialty nature of the AIUM. This event brings together physicians, sonographers, scientists, students, and others from at least 20 specialties–all focused on medical ultrasound! No other event–or professional society–does this. To all of those who joined us in Orlando, thanks and we hope you were able to take back some contacts, a lot of information, and resources to improve patient care. For everyone else, we hope to see you in New York City for AIUM2020.

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Physics of Ultrasound

Snell’s Law [in-class demonstration]

The concept that sound reflects and propagates in varied angles is an abstract concept that many students struggle to understand. I review this concept by providing an in-class demonstration that makes this less abstract and something that can be seen with glasses of liquids.

Evans_Fig 1

 

If speed 1 < speed 2, then the incident angle < transmitted angle.

The difference in the stiffness and resulting propagation speeds helps to explain why the straw appears to be “broken” when you look through the side of the glass of water. The angle of transmission is measured against the vertical black line drawn on the glass of water. This helps to illustrate the 30-degree oblique incidence vs. the increased angle of transmission. A real-world example would be the change in imaging of a needle in a fluid-filled structure.

Example:

The propagation speed of sound through air is 900 m/sec while the propagation speed of sound through water is 1200 m/sec. To figure out the change in the angle of transmission, we form a ratio that will allow us to arrive at a percentage of change. So, 900/1200 = .75 and, therefore, that ratio of change from air to water in the glass is 100 – 75 = 25%. To figure out the angle, take 30 times .25 = 7.5 degrees. Therefore, 30 + 7.5 = 37.5 degree angle of transmission.

Now, consider a different glass of liquid as part of this demonstration by viewing a glass of Karo syrup.

Evans_Fig 2

This time, the glass is filled with Karo syrup, which is stiffer and denser than the water, and the transmitted angle is greater due to the increased ability to travel quickly in the second media.

 

If speed 1 < speed 2, then the incident angle < transmitted angle.

Example:

The propagation speed of sound through air is 900 m/sec while the propagation speed of sound through Karo is 1500 m/sec. To figure out the change in the angle of transmission, we form a ratio that will allow us to arrive at a percentage of change. So, 900/1500 = .60 and, therefore, the ratio of change from air to Karo syrup in the glass is 100 – 60 = 40% gain. To figure out the angle, take 30 times .4 = 12 degrees. 30 + 12 = 42 degree angle of transmission. The real world example for this is noting a speed propagation artifact.

A final demonstration can be a glass that has 1/3 air, 1/3 vinegar, and 1/3 cooking oil. Do not forget to add a straw so that several bends in the straw are noted by viewing through the side of the glass.

 

 

Kevin D. Evans, PhD, RT (R) (M) (BD), RDMS, RVS, FSDMS, FAIUM, is Chair and Professor of Radiologic Sciences and Respiratory Therapy at The Ohio State University in Columbus, OH.

 

Life Hacks for the 2019 AIUM Convention

If you will be joining us in Orlando for the 2019 AIUM Convention, here are a few things you can do to get the most out of your experience:

GET REGISTERED

Register to attend the 2019 AIUM Conventionthe meeting for medical ultrasound, if you haven’t done so already. You have the choice of registering for the whole convention or selecting a 1-day registration, which is available for Sunday, Monday, Tuesday, and Wednesday. Up to 7 CME credits can be earned for each 1-day registration, for a total of up to 28 credits!

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GET THE APP

Before and during the convention, use the app to plan your schedule, read about sessions, take notes, learn about exhibitors, and engage with other attendees. To keep on top of all things #AIUM19, download the eventScribe app now:

(1) Download eventScribe
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(2) Find our event by searching
2019 AIUM Convention

Then, check out the quick video tutorials on how to get the most out of the app.

 

GET SOCIAL

Connect on social media with #AIUM19 on Connect, Facebook, Twitter, LinkedIn, and Instagram.

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GET AROUND

Hilton Orlando Bonnet Creek and Waldorf Astoria Orlando are approximately 18 miles from Orlando International Airport (MCO), which offers information on multiple forms of transportation. The hotels also offer complimentary transportation to Disney® theme parks. For the current shuttle schedule, access the Bonnet Shuttle website, visit the front desk, or call the hotel at 407-597-3600.

Transportation

 

GET MOVING

Each morning of the main convention, at 6:30 am, join us for a bit of fitness to start your day.

  • Sunday: Morning Run (meet in the Hilton Lobby)
  • Monday: Yoga (meet in the Bonnet Creek Pavilion on the Ground Level)
  • Tuesday: Morning Run (meet in the Hilton Lobby)
  • Wednesday: Boot Camp (meet in the Bonnet Creek Pavilion on the Ground Level)

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GET MORE 

New this year: Power Hour Lunch. This year you have the opportunity to attend sessions during lunch. Grab a bite in the Exhibit Hall and keep the learning going!

PowerHour

 

GET A 1ST LOOK AT NEW PRODUCTS

Visit the Exhibit Hall to see the following new products:

Exibitors

While you’re in the Exhibit Hall, check out MEDNAX in booth 504 to learn about career opportunities for radiologists and maternal-fetal medicine specialists. And stop by the ARDMS (booth 228) to pick up one of their “world-famous” pizza cutters.


GET SOME REST

Need to relax? Need to charge your cell phone? Do both at the new Recharge Lounge, located just outside the Exhibit Hall.

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GET BUTTONS

Throughout the convention, we have scattered buttons, each representing 1 of the 20 AIUM specialty-focused communities. Collect all of the communities! If you collect at least 15, you can enter a drawing to win a smartwatch.

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GET REFRESHMENTS

If you are feeling a bit peckish, stop by the Exhibit Hall or the Foyer just outside of it to grab some refreshments.

Refreshments

 

GET TOGETHER

Check out the many networking opportunities available at the 2019 AIUM Convention:

  • Attend community meetings to meet with colleagues in your specialty
  • Mingle at the Welcome Reception
  • Connect with other attendees using the Mobile App
  • Stop by our Resource Booth to volunteer to get involved

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Helping Correct Anterior Pelvic Tilt to Eliminate Hip and Low Back Strain

If you’re having problems with tightness in the hip area and lower back, it might not just be tight muscles, but how your hips are positioned. Here, we show you a few movements to help fix ANTERIOR PELVIC TILT.

Before we get rolling, let’s explain what anterior pelvic tilt is.

It’s when your pelvis ends up tilting forward (or anterior; see image below).

Two images of a skeleton shown from the side. The 1st is shown with good posture and the 2nd shows bad posture with anterior pelvic tilt.

When this happens, it ends up changing the position of your pelvis, hip, and lower back. It also changes the location of your head position, the curve of the spine, and can even lead to knee and ankle problems. This change in the position can cause you to end up having more stress on your hip, back, and knee, which increases the risk of injury and pain.

3 Stretches to Help LIVE PAIN-FREE and Correct Anterior Pelvic Tilt

#1 – 90/90 Hip Flexor Stretch

On a mat, kneel down with the front leg up, with the knee at 90 degrees, the back leg is on the ground, but also bent at 90 degrees. Make sure to tighten up the abdominal area. Then, move your hips forward, maintaining shoulders back. You are looking for a stretch in front of the hip.

You will feel the stretch in the front of your hip and the thigh. You are looking for a light stretch. You are not trying to rip the muscle apart. Hold that for about 20 to 30 seconds, twice on each side: first the right leg, then the left. Alternating back and forth for the two sets.

Image demonstrating the 90/90 Hip Flexor Stretch. A man is shown with his left leg kneeling with the knee at a 90-degree angle and the right leg up, as if he were sitting on a chair, with the knee at 90 degrees.

#2 – Side Lying Quad Stretch

Lying on your side, reach back and grab the foot of the top leg with the same side’s arm as the leg you are bending. As you grab the foot, bring the heel towards the butt. The key here is not to just pull the heel to the butt but bring the thigh back a little bit in order to intensify the stretch in the front of the thigh and the front of the hip. Think – PULL THE HEEL AWAY FROM THE BUTT 6–8 INCHES.

You are looking at holding the light stretch for 20 seconds and you will do it twice on each side, alternating: Right Leg, then roll to other side and do Left Leg. Repeat.

Image demonstrating the Side Lying Quad Stretch. A man is shown lying on a mat on his left side. His left arm is bent at an angle to support his head and his left leg is straight. His right leg is bent at the knee and he is holding his right foot with his right hand.

#3 – Deep Squat Stretch

Stand up tall with a wider stance then shoulder width. From that position, squat down with hips below the knees. In the bottom position, place the elbows between the knees and then push the knees out with the elbows. You are looking for a stretch in the inner thigh and hips.

This position and pressure will end up changing the position in the lower back and in the pelvis from an anterior tilt to a posterior tilt. Perform this stretch twice with a 20- to 30-second hold for each.



What stretches do you do? How do you improve your posture? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

Mark “Coach Rozy” Roozen, MEd, CSCS, NSCA-CPT, TSAC-F, FNSCA, is a certified strength and conditioning specialist, a certified personal trainer, and a fellow of the National Strength and Conditioning Association (NSCA).

Doug Wuebben BA, AS, RDCS (Adult and Peds), FASE, is a registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers. He has also been published on the topics of telemedicine and achieving lab accreditation.

Wuebben and Roozen are co-founders of Live Pain Free — The Right Moves. They can be contacted at livepainfree4u@gmail.com.

Ultrasound at 18,000 ft.

A brief history of the making of Solar‐Powered Point‐of‐Care Sonography: Our Himalayan Experience (J Ultrasound Med 2019 doi.org/10.1002/jum.14923).

Dr Mark Kushinka and Dr Rob Razick are sitting at camp in Phirste La Pass at 18,208 ft. The camp is designated by banners of alternating color flags attached to the top of a pole and pinned to the ground. Mountains are shown around them with blue sky.

Dr Marc Kushinka (left) and Dr Rob Razick (right)
 in Phirste La Pass at 18,208 ft.

Full disclosure… I wasn’t actually there.  Anyone who knows me knows I am not the “sleeping with yaks, no shower for a month” kinda girl. I also have no shame in admitting that I had no chance of surviving the 80+-mile trek 3 miles high amongst the clouds. Fortunately for me, and the people who inhabit the Zanskar Mountain Range, I had 4 residents who wanted to spend several months hiking through a mostly impassable mountain trail providing care to those who live in this spectacular part of the world. Our Lumify’s passport had already amassed an impressive collection of stamps, but none of them as remote as the Himalayas. There is no electrical infrastructure in this region, and all sources of energy come from kerosene, dung briquettes, or solar power. As Dan and Zac departed for India, we had no idea if this crazy plan to operate the ultrasound solely off of a portable solar pad was going to work. Frankly, I was a bit worried that I was adding a few extra pounds to their pack for no good reason. But, after spending 30 days in one of the most remote locations on this Earth, the guys returned with some great stories, good images, and a ton more facial hair.

Dr Daniel Baker and Dr Zac Hardy are shown standing together in Phirste La Pass by a snow-tipped mountain peak.

Dr Daniel Baker (left) and Dr Zac Hardy (right) 

 As I sat curled up in my leather chair with a supple cabernet, I reviewed the data from their trip and realized just how awesome this was. There had never before been medical imaging accessible at this elevation, and its availability had a direct impact on patient care. We repeated the adventure the following year with a new set of residents and the same cheap solar pad from Amazon. After some minor modifications based on our lessons learned from our inaugural year, Marc and Rob yielded more consistent scan times and reliable use.

I truly believe solar powered POCUS can change the face of austere medicine. All you need is a solar pad, a portable ultrasound, and the desire and willingness to leave the comfort of home. Or at least have a few residents up for the adventure.

Cheers from Kashmir!


Have you performed ultrasound examinations in remote regions? What was your experience? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community. Visit the Journal of Ultrasound in Medicine online.

Laura Nolting, MD, FACEP, is the Director of Emergency Ultrasound and the Ultrasound Fellowship Director for the Department of Emergency Medicine at Palmetto Health Richland in Columbia, South Carolina.

The Democratization of Point-of-Care Ultrasound

The subtle sound of a distant explosion rang out. We barely flinched, numb to the sound that was a near-daily occurrence at our remote outpost in war-torn Afghanistan in 2005. Minutes later, a fast-approaching Humvee suggested that this time, something was amiss. The sight of a bloodied soldier draped over the vehicle’s hood provided confirmation.

CPT Jonathan Monti, left, and Lt. Col. Robert Craig, in the army physical training shirt, treat a trauma casualty at Forward Operating Base Ripley in 20005.

As we scrambled to prepare our dusty, sparsely equipped treatment tent, casualties poured through the door. A young Afghan man, triaged as minimally injured, lay in front of me, peppered from head to toe with small shrapnel wounds. His wounds were indeed benign-appearing, as his triage category suggested, but penetrating wounds can be deceptive. I struggled to gauge whether his lack of responsiveness to my questions was due to our language barrier, or something more sinister like blunt or penetrating head trauma. His primary survey was otherwise unremarkable…nosignificant external hemorrhage, airway intact without labored breathing. His blood pressure was borderline low, not an uncommon finding in the thin/healthy. 

I dusted off the nearby SonoSite 180, now widely considered to be the first portable ultrasound device of its kind. Most of its knobs were still foreign to me, and my inexperienced eyes struggled to interpret the grainy images. His belly and lungs appeared unremarkable, but scanning through his subxiphoid region, the black stripe encircling his heart jumped out at me, inconsistent with my already-anchoring bias of a traumatic brain injury, but consistent with the images I had only seen in Ma and Mateer’s landmark text.

I quickly called the surgeon, whose experience with the device barely surpassed my own. After a quick look at both the machine and text, he commanded his team to prep the operating suite, an equally dusty, adjacent tent. Minutes later, the surgeon’s skillful incision of the patient’s pericardium evacuated the now-tamponading bloody effusion, revealing the tiny piece of shrapnel embedded within the patient’s right ventricular wall and saving the patient’s life.

On that day, the humbling and lifesaving power of point-of-care ultrasound (POCUS) was revealed to me. As a junior clinician with limited trauma experience, I had no formal ultrasound training, mentorship, or experience. Yet this machine, when coupled with only a book, and the desire to learn, allowed me the opportunity to overcome the shortcomings of my physical exam skills, my resource constraints, and my cognitive bias, and the mistriage of another, to ensure a patient received the timely and definitive care he deserved. In the decade or so since, I have been fortunate to serve my patients while under the tutelage of several POCUS experts whose altruistic and thoughtful mentorship allowed me the opportunity to cultivate my passion for this powerful tool, while also imparting the nuances and limitations of POCUS, frequently leading me back to a common question:

How can we best harness the full power of POCUS?”

There is a rapidly growing body of evidence that suggests that clinicians of various skill levels can effectively employ focused POCUS applications with minimal training. Though not without risk, POCUS is no different from other clinical skills; performed with variable competency regardless of profession, specialty, or scope of practice. Some will evoke the mantra of “a fool with a tool is still a fool,” which may certainly be true, but it is unfair to assume that foolhardiness is necessarily bound by profession, experience, or even breadth/depth of training.  

The notion that POCUS can/should only be monolithically employed by a limited number of broadly/extensively trained physicians may be yet another example of the monoculture of thought that continues to plague our healthcare system. Certainly, any diagnostic testing should be performed thoughtfully; but do we limit who can use the stethoscope, or order a CBC, based upon title or his/her knowledge of Bayesian principles, Fagan’s nomogram, or pre/post-test probabilities and test-characteristics? Do all successful clinicians adhere to these principles with each and every test they order? Are there other factors to consider when ordering diagnostic testing, particularly in the resource-constrained areas where POCUS can have the greatest impact?

Until POCUS is adaptably and appropriately employed by all those who provide care, regardless of practice setting and scope, its full benefit and potential, especially to those living in medically underserved areas, cannot be realized. Some will inevitably oppose this concept, citing concerns with expertise, patient safety, documentation, reimbursement, etc. Ironically, it is these same arguments that emergency physicians faced 2 decades ago before successfully overcoming significant resistance to fully integrate POCUS into emergency medicine practice.

POCUS leaders are uniquely poised to best mitigate the risks associated with POCUS use through the provision of expanded training opportunities that are well-crafted, appropriately focused, and variably commensurate with clinicians’ skills, cognition, practice setting, and scope. Some of our most innovative POCUS educators are already doing so, whether by incorporating POCUS into the physical exam, or training nurses to perform diagnostic ultrasound, or training medics to employ ultrasound in austere locations. The rise of artificial intelligence/machine learning is already reducing the training burden traditionally associated with POCUS.

POCUS is a rare technological tool; one that is portable, versatile, and liked by both patients and clinicians alike. It can expedite diagnosis and care, improve the accuracy of our physical exam, and help us overcome our own anchoring bias while reducing the risk of procedural error, healthcare cost, and iatrogenic radiation exposure. Though it may not impact a majority of patients, for those it does, that impact is often significant. But the most uniquely promising characteristic of POCUS that we should all embrace is its ability to bring better-informed clinicians of any ilk, back to the bedside where they belong, wherever those in need of care may be.


Do you believe the democratization of point-of-care ultrasound can enhance patient care? Share with us your thoughts or your efforts to do so: comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

Dedicated to the memory of CPT Jeremy A. Chandler, 1st BN, 3rd Special Forces Group, whose life was lost while bravely serving his country on that fateful day, August11th, 2005, in Tarin Kowt, Afghanistan.
https://www.greenberetfoundation.org/memorial/jeremy-a-chandler/

Jonathan Monti, PA-C, RDMS, is an Associate Professor of Emergency Medicine PA Studies at Baylor University and president of the Society of Point-of-Care Ultrasound (SPOCUS). He is currently conducting research on the unconventional employment of ultrasound in the U.S. Armed Forces as an employee of the Henry M. Jackson Foundation for the Advancement of Military Medicine.