The Spirit of Collaboration – A Tribute to Carmine M. Valente, PhD, CAE

Are you aware of the depth and breadth of engagement activities at the AIUM? Most likely, our flagship enterprises, such as the JUM and the convention, as well as the 18 (and growing!) communities immediately come to mind. And for almost 20 years, AIUM CEO Carmine M. Valente, PhD, CAE, has been at the heart of it all. As we close out 2016, we say goodbye to a leader, a catalyst, and a friend. While Carmine has set his focus on new adventures in retirement, it’s interesting to note how much the AIUM has grown during his tenure.

Back in 1997, the AIUM had 8 communities, known in those days as sections. There were 2 types of practice accreditation – OB/GYN and abdominal/gecarmneral. There are now 12. The EER, in its infancy, had $47,000 in its coffers. Over time, 8 practice guidelines have grown to 31 practice parameters; training guidelines have expanded from 1 to 12; and the number of societies that have worked with us to develop these tools has expanded exponentially.

This growth is a result of a theme Carmine has instilled throughout his tenure—collaboration. Carmine is often heard declaring “It makes no sense for the AIUM to develop [fill in the blank] without looking outward. The more stakeholders at the table, the stronger the result.” The imaging community recognized this as early as 2007, when RT Image recognized Carmine as one of radiology’s 25 most influential movers and shakers. “Dr. Valente has been a key element in facilitating and coordinating these and other important activities that continue to grow both the AIUM and interest in the ultrasound arena.”

Over time, Carmine has partnered with 10 of AIUM’s 31 presidents, enabling them to achieve their goals and further the AIUM mission. In the last 12 years, the AIUM has hosted 9 forums on a variety of topics with dozens of participant organizations at each; and all within the framework of collaboration: Compact Ultrasound (2004); Training/Exam Guidelines and Scope of Practice (2006/2008); Patient Safety and Quality: The Role of Ultrasound (2007); Point-of-Care Use of Ultrasound (2010); Ultrasound First & Beyond Ultrasound First: Quality Imaging (2012 & 2016); and Ultrasound in Medical Education (2014 & 2015).

In October 2016, the AIUM’s Board of Governors established the Carmine M. Valente, PhD, CAE Distinguished Service Award to memorialize and recognize significant contributions to the AIUM and the ultrasound community as a whole by furthering the multidisciplinary nature and collaborative efforts of the organization. Its first presentation will occur at the 2017 AIUM Annual Convention in Orlando, Florida.

For those who visit the AIUM Headquarters, you will see that the AIUM’s primary conference area has been dedicated as an enduring reminder of Carmine’s Spirit of Collaboration. This space will serve as a center for informing, educating, inspiring, and entertaining, and instill a growing sense of belief and pride in our ability to advance the safe and effective use of ultrasound in medicine.

Today, it is endemic of the AIUM’s culture to ask “Who else should be at the table?” whenever a project is discussed. And for that, we thank you, Carmine.

The spirit of collaboration is, in Carmine’s immortalized words, “to be continued…”

Do you have a memory, thought, or story to share about Carmine? Comment below and on Twitter: @AIUM_Ultrasound.

Glynis V. Harvey, CAE, is the AIUM’s Chief Executive Officer Designate & Deputy Chief Executive Officer.

Puzzle Solver

During the 2016 AIUM Annual Convention, Michael Kolios, PhD, was awarded the Joseph H. Holmes Basic Science Pioneer Award. We asked him a few questions about the award,November 11, 2015 what interests him, and the future of medical ultrasound research. This is what he had to say.

  1. What does being named the Joseph H. Holmes Basic Science Pioneer Award winner mean to you?
    It means a lot to me to be recognized by my peers in this manner. It motivates me to work even harder to contribute more to the community.  I have been associated with the AIUM for a long time and have thoroughly enjoyed interacting with all the members over the years. When I peruse the list of the previous Joseph H. Holmes Basic Science Pioneer Awardees and look at their accomplishments, I feel quite humbled by being the recipient of this award, and hope one day to match their contributions to the field.
  1. What gets you excited the most when it comes to research?
    I get excited when I generate/discuss new ideas, participate in the battle of new and old ideas, and the immensely complex detective work that is required to prove or disprove these new ideas. I thoroughly enjoy the interactions with all my colleagues and trainees that join me in this indefatigable and never-ending detective work, as solving one puzzle almost always creates many new ones. This is what I’ve encountered in the last 2 decades while probing basic questions on the propagation of ultrasound waves in tissue, and how different tissue structures scatter the sound. Finally, I get very excited when I try to think about how to use the basic science knowledge generated from this research to inform clinical practice, and envisioning the day this will potentially make a difference in the lives of people.
  1. How can we encourage more ultrasound research?
    We need to provide the resources to people in order to do the research in ultrasound. Most funding agencies are stretched to the limit and success rates are sometimes in the single digits. This makes it very challenging to do research in general, including ultrasound research. Therefore, pooling resources and providing environments where ultrasonic research can excel will partially help—creating/promoting/maintaining centers for ultrasound research. This can also be promoted through networking and professional societies, such as the AIUM.Another thing to do to encourage more ultrasound research is by demonstrating the clinical impact of ultrasound and how it could be used to save the lives of patients. Only through the close collaboration of basic scientists/engineers with clinicians/clinician-scientists/sonographers can this be achieved. Developments in therapeutic ultrasound for example are very exciting, and have recently attracted the attention of both public and private funding agencies with many success stories. Moreover, providing seed money through opportunities such as the ERR (Endowment for Education and Research) is a step in the right direction—to give people the opportunity to pursue their ideas in the field of ultrasound research.
  1. What new or upcoming research has you most intrigued?
    While I spent a lot of time trying to understand ultrasound scattering, and how changes in tissue morphology influence this scattering, I’m currently dedicating most of my time to the new field called photoacoustic imaging. It is known that conventional clinical ultrasound has relatively poor soft tissue contrast, but in photoacoustic imaging light is used to generate ultrasound. These ultrasound waves, created when light is absorbed by tissue, provides exciting results that allow not only probing tissue anatomy, but also function in ways that not many other modalities can. After the light is absorbed and the waves initiated, everything we know about ultrasound applies—and in fact we can use the same ultrasound instrumentation to create images. I expect this imaging modality to have clinical impact in the near future.
  1. You are well accomplished within the medical ultrasound research community, but when you were young what did you want to be when you grew up?
    When I was young I wanted to be firstly an astronaut, then a philosopher, pondering basic questions and fundamental problems in nature. I ended up studying physics and its applications in medicine. It has been a highly rewarding choice!
  1. If you were presenting this award at the 2017 AIUM Annual Convention, who would you like to see receive it and why?
    I’d like to see someone that has contributed to ultrasound, with work spanning from the basic science/engineering to clinical application! It would also be encouraging to see the next recipient being a woman or minority, reflecting the true diversity from which new ideas come, and representing a constituency for which society has relatively recently given the opportunity to contribute to science in a meaningful and sustained manner.

Who would you like to see win an AIUM award? What ideas do you have to increase the interest in and funding for research? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Michael Kolios, PhD, is Professor in the Department of Physics, and Associate Dean of Science, Research and Graduate Studies at Ryerson University.

Why I Love Credentials

My name is Mike. I am many things, including a veteran, a business man, a coach, and a sonographer. And while the “things” I am change over time, one thing has remained the same: I am a student! This is thompsonmost evidenced by the 8 professional credentials I currently hold.

I have found that after being in the field of ultrasound for more than 2 decades, credentialing and continuing education can distinguish the enthusiastic sonographer from the merely competent one. With the introduction of more focused credentials such as musculoskeletal, breast, pediatric, phlebology, and advanced cardiac subspecialties, sonographers can now stand out from the crowd in terms of awareness and competency while at the same time being on the cutting-edge of the latest techniques and literature.

Acquiring a new credential, or even just studying for the registry examination, requires you to learn valuable new knowledge that may impact the way you treat and diagnose patients. For example, while I was preparing for the RPhS registry, multiple sources recommended a pneumatic compression device to augment venous flow while a patient is standing as an alternative to the patient performing the Valsalva maneuver in order to induce and record venous reflux. For me, this method has helped me better evaluate for this condition with less strain on the patient while eliminating communication barriers that may exist. If I hadn’t been preparing for that exam, I probably would never have learned this technique.

While some credentials are necessary for certain jobs, multiple credentials prove to existing and future employers that you take your profession seriously and you don’t settle for the minimum standard. I am not saying you need to get multiple credentials. If your professional interest does not reach beyond one credential, that is fine, but few ultrasound labs today only perform only one specialty. Echocardiography labs and vascular labs are growing together as cardiovascular labs, and many departments are requiring a more comprehensive knowledge in ultrasound. Credentialing yourself to the highest degree may get you the new job you pursue or secure the one you have. While increased pay is always a motive, sometimes the satisfaction of being able to set yourself apart from others in the field can be just as rewarding.

Some sonographers have the position that if the credential doesn’t come with a pay raise, it’s not worth it. With reimbursement cuts and higher credentialing standards being proposed by private and government payors, my opinion is that keeping your job is a pay raise.

Why do you hold the credentials you have? What are your go-to resources? What book would you like to see written? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Mike Thompson, MPH, RDMS, RDCS, RVT, RPhS, RVS, RCS, RCCS, is Owner of Diagnostic Resources in Perry, Georgia.

 

Obsessed With Ultrasound

1. Tell us how and why you became interested in ultrasound?
During my Emergency Medicine at Mayo Clinic, I gained exposure to point-of-care ultrasound (POCUS) for procedural guidance. I was immediately drawn to the hands-on and technical aspects of using ultrasound, and began advancing my use for diagnostic shihpurposes. After a few cases of diagnosing acute pathology at the bedside (AAA, free fluid, and DVT to name a few), I was hooked! Following residency, I decided to expand my ultrasound training and pursued an Emergency Ultrasound Fellowship at Yale, while also working toward obtaining my Registered Diagnostic Medical Sonographer (RDMS) certification. Ever since I’ve adopted a liberal use of POCUS in my clinical practice, I can say without a doubt that it’s made me a better Emergency Physician, and I can’t imagine practicing without it!

2. Talk about your role as Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto.
I’m thrilled to be able to bring the skills that I’ve learned during my own EUS Fellowship training to the Emergency Medicine community in Toronto! Our team built the Fellowship Program from the ground up, and our Department went all in with the purchase of 4 additional new ultrasound machines and QPath software for archiving. I’m truly proud of what we’ve accomplished. It certainly helps that I have an extremely supportive Department Chair and 2 amazing fellows this year!

3. What prompted the writing of your book Ultrasound for the Win!?
When trying to learn more about ultrasound myself during residency, I found that there was a void in high-yield POCUS books geared toward Emergency Physicians. I found that the few textbooks that were available, while informative, could be quite dense and intimidating to read. So I decided to develop a book that I, myself, and I believe most Emergency Physicians, would appreciate — a case-based interactive and easy-to-read format that’s clinically relevant to our daily practice. It’s a book that a medical student or resident interested in POCUS can easily read and reference during an Emergency Medicine rotation.

4. What’s one thing you learned about yourself through the writing/editing process?
It’s made me realize just how obsessed I am with ultrasound! Writing and putting together the book was hard work, but also enjoyable and extremely satisfying! Seeing these real cases compiled one after another really highlights the potentially life-saving role of POCUS in medicine, and the profound difference it can make in improving patient care and outcomes.

5. What advice would you offer medical students when it comes to ultrasound?
Scan many and scan often—it’s simple; the more you practice POCUS, the better you will be at it! Also, don’t be afraid to take initiative in your own education—while some attendings may not be comfortable enough with POCUS to teach it to you, don’t let that be a deterrent to your own learning. There’s a plethora of resources available online, including Matt & Mike’s Ultrasound Podcast and Academic Life in Emergency Medicine that you can reference!

How did you become interested in ultrasound? What are your go-to resources? What book would you like to see written? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Jeffrey Shih, MD, RDMS, is an Emergency Physician and author of the book Ultrasound for the Win! Emergency Medicine Cases. He is Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto, Canada, and Lecturer in the Faculty of Medicine at the University of Toronto. He can be reached at jeffrey.shih@utoronto.ca and on Twitter: @jshihmd

Research in Ultrasound: Why We Do It

“Medicine, the only profession that labors incessantly to destroy the reason for its existence.” –James Bryce

We all know the important medical discoveries clinical research has given us over time. stamatia-v-destounis-md-facrYou could even make the case that the high standards of care we have today are built on centuries of research.

The world of medical ultrasound is no stranger to clinical research—dating back to the early work of transmission ultrasound of the brain. This work was especially important, as it was the first ultrasonic echo imaging of the human body.

Since then, research has brought about gray scale imaging, better transducer design, better understanding of beam characteristics, tissue harmonics and spatial compounding, and the development of Doppler. All of these research developments, as well as many others, were highly significant and have lead us to today’s high-quality handheld, real-time ultrasound imaging.

For me, the biggest and most important developments were and have been in breast ultrasound. In 1951, the research of Wild and Neal discovered and qualified the acoustic characteristics of benign and malignant breast tumors through use of an elementary high-frequency (15-MHz) system that produced an A-mode sonogram. These researchers published the results of additional ultrasound examinations in 21 breast tumors: 9 benign and 12 malignant, with two of the cases becoming the first 2-dimensional echograms (B-mode sonograms) of breast tissue ever published.

It is research that leads to landmark publications that change the way we practice. The ACRIN 6666 trial led by Dr Wendie Berg and her co-authors evaluated women at elevated risk of breast cancer with screening mammography compared with combined screening mammography and ultrasound. This pivotal study demonstrated that adding a single screening ultrasound to mammography can increase cancer detection in high-risk women. In our current environment this is even more relevant, as breast density notification legislation is being adopted in states across the country. With the legislation, patients with dense breast tissue are often being referred for additional screening services, with ultrasound most often being the screening modality of choice.

Screening ultrasound is an area on which I have focused much of my own research. I practice in New York State, where our breast density notification legislation became effective in January 2013. I have been interested in reviewing my practice’s experience with screening ultrasound in these patients to evaluate cancer detection and biopsy rates. My initial experience was published in the Journal of Ultrasound in Medicine in 2015, and supported what other breast screening ultrasound studies have found, an additional cancer detection rate of around 2 per 1000. Through my continued evaluation of our screening breast ultrasound program, I have found a persistently higher cancer detection rate by adding breast ultrasound to the screening mammogram–which is of great importance to all breast imagers, as we are finding cancers that were occult on mammography.

Participating in valuable research is important to me and my colleagues because part of our breast center’s mission is to investigate new technologies and stay on the cutting-edge by offering the latest and greatest to our patients. Participating in clinical research provides us important experience with new technology, and an opportunity to evaluate firsthand new techniques, new equipment, and new ideas and determine what will most benefit our patients. This is what I find the most important aspect of research, and why I do it; to be able to find new technologies that improve upon the old, to continue to find breast cancers as early as possible, and to improve patient outcomes.

Why is medical research/ultrasound research so important to you? What research questions would you like to see answered? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Stamatia Destounis, MD, FACR, is an attending radiologist and managing partner at Elizabeth Wende Breast Clinic. She is also Clinical Professor of Imaging Sciences at the University of Rochester School of Medicine & Dentistry.

Greater Trochanteric Pain Syndrome

In a study funded in part by AIUM’s Endowment for Education and Research, Jon Jacobson, MD, and his team from the University of Michigan set out to determine the effectiveness of percutaneous tendon eer_logo_textsidefor treatment of gluteal tendinosis. The full results of this study were recently published in the Journal of Ultrasound in Medicine.

Greater trochanteric pain syndrome is a condition that most commonly affects middle-aged and elderly women but can also affect younger, and more active, individuals. It has been shown that the underlying etiology for greater trochanteric pain syndrome is most commonly tendinosis or a tendon tear of the gluteus medius, gluteus minimus, or both at the greater trochanter and that tendon inflammation (or tendinitis) is not a major feature. This condition can be quite debilitating and often does not respond to conservative management.

Treatment of greater trochanteric pain syndrome should therefore include treatment of the underlying tendon condition. Ultrasound-guided percutaneous needle fenestration (or tenotomy) has been used to effectively treat underlying tendinosis and tendon tears, including tendons about the hip and pelvis. Similarly, autologous platelet-rich plasma (PRP), often combined with tendon fenestration, has been used throughout the body to treat tendinosis and tendon tears.

Although studies have shown patient improvement with PRP treatment, the true effectiveness of this treatment compared to other treatments remains uncertain. Although percutaneous ultrasound-guided tendon fenestration has been shown to be effective about the hip and pelvis, there are no data describing the use of PRP for treatment of gluteal tendons, and there is no study comparing the effectiveness of each treatment for gluteal tendinopathy. The purpose of this blinded prospective clinical trial was to compare ultrasound-guided tendon fenestration and PRP for treatment of gluteus tendinosis or partial-thickness tears in greater trochanteric pain syndrome.

We designed a study in which patients with symptoms of greater trochanteric pain syndrome and ultrasound findings of gluteal tendinosis or a partial tear (<50% depth) were blinded and treated with ultrasound-guided fenestration or autologous PRP injection of the abnormal tendon. Pain scores were recorded at baseline, week 1, and week 2 after treatment. Retrospective clinic record review assessed patient symptoms.

To break this down a little further, the study group consisted of 30 patients (24 female), of whom 50% were treated with fenestration and 50% were treated with PRP. The gluteus medius was treated in 73% and 67% in the fenestration and PRP groups, respectively. Tendinosis was present in all patients. In the fenestration group, mean pain scores were 32.4 at baseline, 16.8 at time point 1, and 15.2 at time point 2. In the PRP group, mean pain scores were 31.4 at baseline, 25.5 at time point 1, and 19.4 at time point 2. Retrospective follow-up showed significant pain score improvement from baseline to time points 1 and 2 (P < .0001) but no difference between treatment groups (P = .1623). There was 71% and 79% improvement at 92 days (mean) in the fenestration and PRP groups, respectively, with no significant difference between the treatments (P >.99).

These results led us to conclude that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups.

What is your experience with treating greater trochanteric pain syndrome? Are you familiar with the Endowment for Education and Research?  Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Jon A. Jacobson, MD, is Professor of Radiology, Director of the Division of Musculoskeletal Radiology, Assistant Medical Director of Northville Health Center, and Medical Director of Taubman Radiology within the University of Michigan Health System.

Who Runs the AIUM?

Have you ever wondered what or who runs the AIUM? Of course you know about the elected officers, and the AIUM staff that works in the home office, but do you know that there are approximately a dozen committees and/or task forces that help the organization run throughout the year?

The volunteers may be elected or appointed to the committees and tasks forces, and they are not paid or compensated for their time. Frequently, there are many committee members who accept appointments and nominations year after year. Who would possibly be willing to take on extra work and added expense, just to help the AIUM?

Bagley_6Who are the volunteers?
Ordinary people like me! That is who! I have been volunteering with the AIUM since 2009, and have found, as they often say when you volunteer, that I get more than I give. My personal life mission is one of giving back, both to my profession and to my community. I believe anyone who volunteers for the AIUM will give you a similar answer: There is an obligation to give back because someone once gave of his or her time to help me.

How did I become a volunteer?
I did not wake up one day and think to myself, “Today is the day I should volunteer for the AIUM.” Instead, a mentor suggested to a liaison organization that I should be their representative to the AIUM Bioeffects and Safety Committee. At the first meeting, I was hooked. The work gave me new energy and excitement about my profession. I could not get enough bioeffect and safety knowledge.

When my time as a liaison ended, I asked a fellow committee member to nominate me to the committee. As luck would have it, my work proved that I was serious, and the members elected me to the committee.

How can you become a volunteer?
Maybe you are thinking to yourself right now, I am energetic and have a lot to give, but I do not know how to get involved. What should I do? If you have a mentor in the AIUM, ask him or her to nominate you to a committee.

If you do not have a mentor I suggest that you start by serving as a resource member to the committee that best matches your skills and interests. A resource member might assist the members on projects. You can offer up your talents by contacting the chair and letting him or her know that you want to help. Once your work is visible, you can ask a member to nominate you to be a committee member.

You Get More Than You Give
I have gained so much from working on a committee. I have new knowledge about bioeffects and safety that has allowed me to take on a larger advocacy role. I have new knowledge to integrate into the courses that I teach, and I have developed lectures to educate all medical imaging professionals about ultrasound bioeffects and safety. The work on the committee has inspired my own research projects that have resulted in award-winning manuscripts.

My confidence in my knowledge has improved, and I am willing to try new and difficult projects that I would not have dreamed of trying in my pre-committee life. I have made friends and have gained new mentors. I know that regardless of how much effort I have given, the committee has given me exponentially more.

Member, Pay it Forward!
None of us ever gets where we are on our own. In addition to our hard work, our mentors and our colleagues help us on our professional journeys. Volunteering is a way to pay it forward.

If you are an active volunteer, now is the time to make sure your good work is continued! Mentor a new member, and help him or her get involved. Suggest that he or she become a resource member or nominate him or her to a committee. Bringing new people into the volunteer world ensures that your good work continues, and it provides for the AIUM’s future.

Interested in volunteering for the AIUM? Check out the volunteer page. What has been your volunteer experience? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer Bagley, MPH, RDMS, RVT, is an associate professor for the College of Allied Health at the University of Oklahoma Health Sciences Center, Schusterman Campus in Tulsa. She currently serves on the AIUM Bioeffects Committee and is a former member of the Technical Standards Committee.