Handle the Scan with Care

Anytime one begins an obstetrical scan, there is a ritual that precedes our privileged access into an otherwise inaccessible place pulsating with life, hope and promise. The trilogy of preparing the patient, applying the gel, and selecting the transducer helps us transition as we open a window to the womb, sharing a highly anticipated and treasured moment with the family.

old windowWhile this privileged access may provide priceless reassurance, it is accompanied by a huge responsibility for the sonologist who is attempting to make sense of what is seen while trying to decide how to share the information with the family.

As diagnosticians, we are taught to be vigilant, careful and meticulous, making note of every single finding. We employ the most sophisticated machines and the importance of being non-paternalistic is deeply engrained in our brains. Yet at the same time, care and caring must come into play if we need to break news that may shatter dreams or induce significant parental anxiety.

Personally I find that the most challenging cases are those in which various isolated sonographic markers may be detected. The struggle between wanting to be scientific, factual and transparent and the fear of labeling an otherwise healthy being and worrying a hopeful parent becomes paramount. This is becoming more commonplace nowadays with the advancing technology as we delve into fetal evaluations with much more detail and at earlier points in gestation. We must not mistake normal developmental findings with pathology. We must be careful with enhanced image resolution and the employment of harmonics as these may increase tissue echogenicity and lead to over diagnosis of physiologic “cysts” in fluid producing structures.

With the continuing advancement of the technological capabilities of this most versatile of medical diagnostic modalities and its evolving portability, the number of probe-handlers globally is increasing exponentially across the disciplines. The problem is that education, training and experience are not uniform. The expertise to discuss the implications of various sonographic findings, particularly soft markers, and to recognize serious abnormalities, may be lacking. Despite the well-established positive impact of prenatal diagnosis, allowing us to prepare families and formulate the optimal plan of care, it may also be a double-edged sword, particularly in inexperienced hands.  As such, and in keeping with the mission of the AIUM and its communities of practice, the importance of proper training cannot be overstated. One must adhere to the basic sonographic teachings, employ the ALARA principle, and implement practice parameters when incorporating sonography into daily clinical practice. Referral to centers of excellence, whenever there may be doubt, is critical. Sound judgment remains the key to utilizing ultrasound first.

A new life is purity in the absolute form: a blank sheet of paper. Much caution must be exercised before any marks are made. Every word uttered has the potential of tainting the page, of taking away hope, of falsely “labeling” this promising life before it has even come into physical being. “First do no harm” should continue to echo in our brains and we must always proceed with caution, and tread with care.

What’s your opinion on the quality issue? Do you see a wide range of quality in ultrasound scanning?  Comment below or let us know on Twitter: @AIUM_Ultrasound.

Reem S. Abu-Rustum, MD, FACOG, FACS, FAIUM, is the Director of the Center For Advanced Fetal Care in Tripoli, Lebanon. She has served the AIUM in several capacities, including her current role on the AIUM Board of Governors.

  • Image adapted from A Practical Guide to 3D Ultrasound. RS Abu-Rustum. CRC Press 2015.

Record-setting OB Course

Last week, a record number of 444 physicians and sonographers gathered in Orlando, Florida, for the 38th Annual Advanced Ultrasound Seminar: OB/GYN. The program, which was co-directed by Lennard Greenbaum, MD, and Frederick Kremkau, MD, featured an impressive array of speakers, all of whom have been presidents (plus the incoming president-elect) of the AIUM.

Over thOB course 2015e course of 3 days, attendees heard from these experts on a wide variety of topics, including ovarian cancer screening, fetal malformations, endometriosis, fetal cardiac imaging, and adnexal masses. You can find the full schedule, plus a list of the faculty here.

By all accounts, this year’s event was a success. Here are just a few comments from attendees:

  • “I love this course. This is my 8th year attending and every year I take home a couple of real ‘pearls’ to assist me in improving the studies that I do in our office.”
  • “Overall excellent course – well organized, great venue/location, excellent lectures which are clinically relevant.”
  • “I have attended this conference several times in the past and always learn either a new technique or something very beneficial I can bring back and share to help improve patient care.”
  • “I’m really impressed with how clear and applicable this information was.”

And these comments played out in the survey results, as 64% said that this course was better than others they have attended and 97% said they would recommend this course to their colleagues.

The co-directors and AIUM are already hard at work planning next year’s course, which will be held February 18–20 at Walt Disney World’s Yacht and Beach Club Resorts. Keep an eye on The Scan and the AIUM website for details as they become available. And if you are interested, register as soon as it opens because 91% of this year’s attendees said they were very likely to attend another AIUM post-graduate course.

Did you attend this year’s event? If so, share your thoughts. Going next year? Let us know what you want to learn! Comment below or let us know on Twitter: @AIUM_Ultrasound.

Peter Magnuson is AIUM’s Director of Communications and Member Services.