A Major Boon for Physical Therapy

As a second-year physical therapy (PT) student, I was first introduced to ultrasound for musculoskeletal conditions in 2009.

I was immediately intrigued.Headshot

I continued to dabble in musculoskeletal ultrasound (MSKUS) for a couple of years but never really with a focus on becoming good or great at the skill, more on the emphasis of becoming more knowledgeable and comfortable with human anatomy (ie, looking at muscle pennate structure, fibrillar patterns of tendons and ligaments, and identifying what they were).

Then, in 2011, I sought out a mentor for MSK ultrasound whom I had known since PT school, Wayne Smith, who is also a physical therapist with 40 years of experience. Wayne has been doing MSKUS since 2000 and in 2011 was working at Andrews Institute with Josh Hackel in the physical therapy department.

Soon after starting the training, Wayne and I collaborated with my PT clinic owner to help create a physical medicine model combining physiatry with physical therapy; MSKUS was a large piece of this model.

We quickly realized how powerful MSKUS had become and that it had turned into a gatekeeper and point-of-care diagnostic tool. MSK ultrasound is a great adjunct to evaluating a patient at time zero and in the hands of qualified physical therapists with requisite training. MSKUS allowed the clinic to execute and expedite patient plan of care by immediately cutting out unnecessary imaging studies (MRI mainly), streamlining physical therapy plans, aiding the physician with percutaneous-ultrasound-guided needle procedures, and/or immediate referral for surgical consult or advanced imaging if needed.

At this time, the RMSK exam was not on my radar so the training was piecemeal; I made the most out of my time to train with Wayne every 6 weeks while practicing and reading Jon Jacobsen’s Fundamentals of Musculoskeletal Ultrasound book.

In 2014, I took on a part-time trial with an orthopedic surgeon performing MSKUS in his office as well as physical therapy services consisting of evaluation, therapeutic exercise, and home exercise prescription. This business model became very successful and super-charged my learning in MSK ultrasound because I was now able to get feedback not only with other imaging studies, such as MRI, but I was then able to synergize findings in surgery that were based on the MSKUS imaging studies (ie, bursal sided rotator cuff tear vs intrasubstance). This feedback was very valuable and accelerated my learning curve. This orthopedic clinic is now an AIUM-accredited diagnostic center in MSK ultrasound within the state of Arizona.

In the medical model or in a stand-alone outpatient physical therapy practice, incorporating orthopedic physical therapy evaluation, MSK ultrasound evaluation combined with exercise prescription is a very powerful visit for the patient. It cuts out unnecessary imaging, saving the patient money and additional timely medical visits as well as expediting the patient’s plan of care. I’ve since incorporated this business model to many other physician offices in the greater Phoenix area.

Incorporating MSKUS into physical therapy has been a major boon for the profession and for the medical community in general.

My workweek now consists 100% of performing MSKUS scans, teaching at A.T. Still University (Mesa), starting up an online MSKUS training program, and mentoring physical therapists, athletic trainers, general sonographers, and radiology technicians in the field of musculoskeletal ultrasound in their preparation to take the RMSK or RMSKS certification exam.

Interested in reading more about how ultrasound can change physical therapy? Check out Carrie Pagliano’s post, Real-time Ultrasound in Physical Therapy.

Colin Thomas Rigney, PT, DPT, OCS, RMSK, is the Director of MSK Ultrasound for Physicians United as well as a member of both the Residential and Post-Professional Doctor of Physical Therapy Degree Faculty at A.T. Still University in Mesa, Arizona, teaching courses on Radiology and Imaging for Physical Therapy students.

 

Have you incorporated musculoskeletal ultrasound in your physical therapy practice? What benefits have you experienced? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

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POCUS: A Holiday in the Sun

Getting started with point-of-care ultrasound (POCUS) is like taking a vacation in Bali, Bermuda, or the Bahamas.  Let’s say you’ve landed in an exotic destination and plan to rent a car to explore the island. After collecting your keys, what’s next? Jump in the vehicle and peel off to the beach? Of course not – you’ll take a minute to consider the controls of your car, where you’re going, and how you’ll get there. POCUS is no different from a dream island visit.

Mackenzie headshot 2

In an unfamiliar vehicle, it’s normal to become acquainted with the controls. You want to know how to turn on the car’s lights and wipers and position the mirrors and windows appropriately. There’s a direct analog in performing a POCUS study. The operator has to select the correct transducer and examination preset before getting started. If it’s a machine you’re not familiar with, you need to take a moment to locate essential controls such as depth and gain. Even if the machine is familiar, you need to optimize those settings to ensure you can obtain quality images, just as you would with the mirrors in your car.

It’s also second-hand nature to adjust a car for comfort. The seats and steering wheel need to be positioned so you have a comfortable trip, and the climate settings arranged for passenger comfort. For a successful POCUS scan, the same steps should happen. Both the operator and the patient should be comfortable and positioned correctly. That means adjusting the bed, lowering the side rails, and placing the patient and machine where you can obtain adequate images while ensuring no one has to be a contortionist.

Taking a car on the road on unfamiliar roads can be stressful, and more so if you’re not used to driving on the left. If driving on the opposite side of the road is unfamiliar, it’s smart to visualize how you will be oriented on the road and during turns before heading out on the road. Successful POCUS users have the same habit: they understand where the indicator marker is on both the screen and the transducer before acquiring images. Failing to do so leads to confusion and a breakdown of pattern recognition, just as driving on the left might.

With the car and orientation controls sorted, you’re still not going to fire up the engine yet. Most travelers take a moment to figure out where they’re headed, with a GPS or map. The sonologist needs to take the same step, remembering the focused question they’re trying to answer with the POCUS study, and what they need to see to be satisfied. While you might be happy to ramble aimlessly in a car, POCUS scans should stay focused.

Of course, this assumes that renting a car is the best way to get around the island. Maybe you’d be better served by a taxi, bus, or boat. Or maybe after seeing the rental vehicle, you decide the car can’t accommodate your plans. In the same vein, not all clinical questions can be answered with POCUS. An alternative imaging modality or comprehensive ultrasound may be the test you need, and it’s OK to change your mind and decide you need something else after you perform the scan.

POCUS is rewarding and helps both clinicians and patients, but isn’t always easy. Think of POCUS like the start of a vacation, and you may find your studies are easier, and a bit closer to a holiday in the sun.

 

 

Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

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David Mackenzie, MDCM, is an emergency physician at Maine Medical Center, in Portland, Maine. Follow Dr Mackenzie on Twitter @mackendc.

The Expanding Scope and Diagnostic Capabilities of Vascular Ultrasound

Peripheral Vascular Disease (PVD) in the United States affects approximately 8 million to 12 million patients a year; some experts in the field believe this number may be underestimated. The disease is associated with significant cardiovascular morbidity and mortality, with a high rate of fatal and non-fatal cardiovascular events, such as myocardial infarction, stroke, renal failure, limb amputations, abdominal aortic aneurysms, pulmonary embolus, and progressive ischemic end-organ dysfunction. The reduction in quality of life from global vasculopathy in many patients can thus be significant.

George Berdejo

George Berdejo, BA, RVT, FSVU

Prompt and accurate diagnosis of these disease processes is of utmost importance and high-quality vascular ultrasound plays an essential role. In fact, vascular ultrasound and the role of the vascular ultrasound professional has evolved and expanded rapidly and is at the core of modern vascular disease care in the United States and is emerging around the world.

Vascular ultrasound can be seen at the intersection of imaging, physiology, physiopathology, interventional medicine, and surgery and is utilized widely by healthcare providers from many specialties, including but not limited to vascular technologists and other subspecialty sonographers, vascular surgeons, vascular interventional radiologists, vascular medicine physicians, cardiologists, radiologists, and other vascular specialists with an interest in vascular disease.

At the core of any thriving vascular surgery practice is high-quality vascular ultrasound imaging. Duplex vascular ultrasound (DU) is used to evaluate all of the major vascular beds outside of the heart. The use of duplex ultrasonography for the study of vascular disease is firmly established but is also rapidly expanding. Thanks to continued improvements in the performance of ultrasound devices, vascular ultrasound can be used to perform a greater range of assessments in a noninvasive manner in some cases excluding the need for more invasive, expensive, contrast-based imaging modalities.

The recent proliferation of “less and minimally invasive” endovascular options currently available and offered to patients with various vascular disease processes has mandated better, less invasive, preferably noninvasive methods, to diagnose the disease that is being treated. Advances in technology have increased the diagnostic capabilities of vascular ultrasound and its role not only in diagnosis but also in planning and performing interventions and in patient follow-up and surveillance after intervention. Indeed, vascular ultrasound has become the standard “go-to” diagnostic imaging technique prior to most vascular interventions and has certainly emerged as the imaging technique of choice for following patients after most vascular interventions.

Endograft Evaluation. Duplex vascular ultrasound has emerged as the standard of care for surveillance after endovascular repair of abdominal aortic aneurysms. A major complication of this procedure is endoleak (persistent or recurrent flow within and pressurization of the residual aneurysm sac). This results in persistent risk of aneurysm rupture and potential death. Ultrasound assessment allows imaging and Doppler interrogation of deep structures and low-flow detection capabilities needed in patients with low-volume/low-velocity endoleak. Duplex vascular ultrasound, in good hands, has supplanted computed tomographic angiography as the primary surveillance technique in these patients. In addition, DU allows for the ability to resolve the deep structures of the abdomen to measure aneurysm sac size.

Hemodialysis Access Mapping and Surveillance. Higher frequency, better resolution, smaller footprint transducers that are currently available provide the high-resolution images that are needed to assess the veins and arteries of the upper extremity in order to plan the optimal access sites and also to provide the surveillance often needed postoperatively in order to maximize the life of the access and the quality of life for the dialysis patient.

Lower Extremity Vein Reflux Testing. Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. An estimated 40 percent of people in the United States have CVI. The seriousness of CVI, along with the complexities of treatment, increase as the disease progresses. Duplex ultrasound is integral in the evaluation, treatment and follow-up of these patients. Absent the appropriate equipment, the initial duplex reflux scan is among the most physically challenging, labor-intensive scans performed in vascular ultrasound. These exams account for 20%–25% of all the ultrasound scans performed in our practice.

Lower Extremity Arterial Mapping. Our philosophy regarding the practical evaluation of patients with known peripheral arterial disease who require intervention includes the use of duplex ultrasound as the primary first-line imaging modality precluding the use of more expensive, invasive, and nephrotoxic diagnostic arteriography in most patients.

Vascular ultrasound is now being used by increasing numbers of specialists who are employing both traditional and newer cutting-edge methods and techniques to improve patient care and management and who are dedicated to the delivery of quality care to their patients.

The future is bright for both vascular ultrasound and the vascular sonography professional!

 

Do you have any tips for performing vascular ultrasound? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

 

 

George Berdejo, BA, RVT, FSVU, is Director of Vascular Ultrasound Outpatient Services at White Plains Hospital in White Plains, New York. He is the Chair of the AVIDsymposium (www.AVIDsymposium.org) and is the current Chair of the Cardiovascular Community of the AIUM.

Novice to Competence to Understanding Our Role as POCUS Educators

Nights at the VA medical ICU could get lonely sometimes. When the hubbub of the day had drawn down and the critical care fellows had gone home, the work in the ICUs slowed.Headshot_kevin piro

I figured that I would make use of the time that had seemingly stopped. I grabbed the ultrasound and went to scan and chat with a friendly gentleman whom I had admitted the previous night. It became readily apparent that I was still a struggling learner at this point in my training. There was something that looked like cardiac motion, but not resembling anything like the diagrams and videos I had looked at on my own. It was an uncomfortable place to be.

I imagine that is where a lot of people get frustrated and stop, especially when they don’t have someone to encourage and nurture their continued practice. I had a different luxury. Just a few weeks prior, I had received an inquiry about participating in a new general medicine POCUS fellowship at Oregon Health & Science University, and I was instantly sold on its potential. Here was a chance to carve out a new path and to invest in a skill that offered me a skillset that could improve my patient care. And I knew that I would have the benefit of POCUS experts literally holding my hand as I learned the skill. What a luxury!

So, I kept scanning in the ICU prior to my fellowship. You know what I found? Patients are much more forgiving than we might imagine them to be. Most understand that hospitals are frequently places of learning and like to be engaged in the process and, as I stumbled through my next few exams, I was reminded of my Dad’s words of encouragement, “the only difference between you and an expert is that they have done it once or twice.” So I kept at it. I was terrible the next times too. But, it got easier and I felt less intimated with each scan I performed. By the time I hit fellowship, I was already moving in the right direction.

When I started my POCUS fellowship, I was fortunate to work with all sorts of supportive colleagues that allowed me to continue to grow. Where I had struggled to build a foundation on my own, colleagues collected from internists, sonographers, and EM physicians provided me with the scaffolding. They provided me with lessons. “Remember, air is the enemy of ultrasound” and “ultrasound does not give you permission to turn your brain off. It is a problem-solving tool.” They entertained clinical application questions. They gave back when I leaned in. These colleagues were an amazing support network and would help me construct the mosaic that I teach from now.

A few months into the fellowship, I could complete a competent exam comfortably. It came together one day for me when I completed a Cardiovascular Limited Ultrasound Exam (CLUE) on a pleasantly demented older man, who had shortness of breath likely representing heart failure. As I looked at his lungs, taking stock of the bilateral B-lines and pleural effusions that confirmed his diagnosis, I discussed and showed the findings with his daughter.

“This makes so much sense now!” she remarked. The lightbulb went on for her as I democratized her father’s clinical information. The lightbulb came on for me too as I had a sense of satisfaction of both feeling confident in my diagnosis, but also being better able to teach and engage a family in their medical care. My transformation from novice to competency was mostly complete.

Now, a little more than 2 years removed from my fellowship, I have a little more perspective on the road from novice to competency, not only from my personal experience but also from my opportunity to network with an amazing group of enthusiastic (IM) POCUS educators.

These educators are largely trained by their own curiosity, their attendance at POCUS CME courses, or by latching onto experts from peripheral medical departments. In essence, these educators are pulling themselves up by their own bootstraps in a time when there is a distinct scarcity of POCUS educators within Internal Medicine, which can leave the supposed “all-knowledgeable” physician in an uncomfortable place of vulnerability. They have shared the angst that POCUS is a particularly challenging skill to learn due to its humbling nature – we may not know how badly we were hearing murmurs as medical students, but I bet most learners can guess by looking at a picture how poorly they are doing when they are scanning. It was a feeling I shared back in the ICU as a resident, but our experiences diverged when I had mentors who invested in me learning this valuable skill.

But, these physicians who learned POCUS independently are now at the next, even harder, part. As new leaders, we must reach behind us and pull up the trainees, whether that be by creating the next POCUS fellowship, starting or improving a residency POCUS program, or simply training your fellow colleague. We are tasked with making new learners feel supported and encouraged, and to make this technology accessible in fields where POCUS is not the standard of care. We need to foster these learners’ growth so that they can arrive at their own lightbulb moment and so they keep scanning on the ICUs in the effort to improve the care they deliver.

 

What was your defining moment in your decision to go into ultrasound? Have you had a unique learning experience? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

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Kevin M. Piro, MD, participated in and helped build a point-of-care ultrasound fellowship at Oregon Health & Science University (OHSU), becoming only the second general medicine-focused ultrasound fellowship in the nation. Dr Piro is now a hospitalist at OHSU.

Who Owns POCUS?

The debate over point-of-care ultrasound (POCUS) governance was rekindled recently when the Canadian Association of Radiologists published a POCUS position statement. The statement rankled some prominent POCUS leaders who hotly debated the statement’s merit via Twitter. This is a debate certainly worth having, but it is hardly a new one. Some likened it to the “turf battles” that emergency physicians successfully overcame well over a decade ago. To be clear, there is a governance problem, largely the result of technology/machine availability outpacing the development of POCUS training, credentialing, and employment guidelines and standards. Referring to the POCUS realm as the “wild, wild west” as Zwank and colleagues did, is somewhat apropos. But to develop the best solutions, we must first define the problem.empty conference room

The problem – “who”…or “how”? The statement seems to frame the problem around who is best qualified to govern POCUS. Most would agree that radiologists are imaging experts with the most training in interpreting ultrasound. But if using Bahner’s popular I-AIM framework, the image interpretation that most radiologists practice is only one aspect of POCUS. POCUS is a separate entity from consultative ultrasound. Clinician-performed at the point of care, POCUS has different goals, primary of which is to answer focused questions that guide and expedite proper definitive care. Its versatility allows it to be employed well outside of the domain of traditional diagnostic ultrasound, enhancing the safety of bedside procedures, improving the physical exam, and directing further testing & timely care. But when did you last see a radiologist at the bedside of a patient outside of the interventional radiology (IR) suite…one willing to personally “clinically correlate” the image findings rather than just include the phrase in their report?

Rhetorical questions aside, if we lived in a perfect and resource-rich world, we might all be able to dedicate a full year to the performance of ultrasound, or even better, radiologists would come to the bedside to perform the exam within minutes of the order. But we don’t. Fortunately, there’s already quite a bit of data suggesting that the requisite training for non-radiologists to safely employ POCUS isn’t as extensive as some might have us think. Additionally, the American Medical Association’s resolution (AMA HR. 802) long ago recommended that training and education standards for the employment of ultrasound be developed by each physician’s respective specialty society, effectively recognizing the importance of self-governance of this modality. I would argue that the problem, therefore, centers less around the “who” and more around the “how” of governance.

Practical solutions – Interprofessional collaboration is key: The desire to ensure patient safety is the common ground here. We all want to ensure POCUS is safely employed, but how do we best do so? Training and utilization standards can ensure this, but overly restrictive standards can create unnecessary barriers that limit POCUS employment and prevent patients from reaping the demonstrated benefits of POCUS. The radiology specialty undoubtedly has a wealth of valuable expertise to contribute to this debate. Their well-established and validated training and imaging standards could well-serve as a framework upon which POCUS standards could be built and certainly makes them deserving of a seat at the table. But given how and where POCUS is employed, surely the clinicians doing so deserve a seat also. To suggest that “non-imagers” are incapable of developing rigorous, evidence-based training and utilization standards that allow for the safe employment of POCUS simply isn’t fair, nor is it well-substantiated, if we’re using emergency physicians as an example.

Furthermore, unilaterally developed statements such as this are what drive us to remain in our respective silos and can hinder the progress still required in this realm. The solution is a collaborative one, considerate and respectful of the diagnostic ultrasound knowledge and experience of imaging experts, the setting in which POCUS is employed, and the variety of ways clinicians can capably employ it to enhance patient care at the bedside. This collaborative concept isn’t mine, nor is it new, thankfully (more thoughtful discourse on the topic can be found here and here). It’s time that we recognize and leverage the talent that each discipline can offer toward the safe, effective employment of POCUS. It’s time to embrace interdisciplinary and interprofessional collaboration.

The inherent value of POCUS lies in its ability to transcend clinical specialties, settings, and practice scopes. It is distinctly different from consultative ultrasound and therefore shouldn’t be bound by standards created long before POCUS existed. It is a valuable, patient-centered adjunct that demands new standards that are 1) considerate of both its versatility and the multitude of settings in which it can be employed, 2) considerate of the experience of those who have previously employed US, and 3) created by all those actively employing it to enhance the care they directly provide at the bedside. But rest assured, ultrasound no longer belongs only to radiologists, or any one specialty/profession for that matter, and that’s a good thing.

 

Have you integrated a collaboratively developed approach to POCUS training and/or utilization?  Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.

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Jonathan Monti, DSc, PA-C, RDMS, is an Associate Professor of the US Army / Baylor EMPA Residency Program at Madigan Army Medical Center and President of the Society of Point-of-Care Ultrasound (SPOCUS). He is actively engaged in research that assesses POCUS training and its unconventional employment by a myriad of users.

A Model Citizen

“Lie down on your back, your elbow is about to get a lot of gel on it,” said the proctor during our most recent AIUM headquarter course. As staff, we often have to step in and assist at meetings in ways we had not planned. This moment was not any different, but we do it because we want to understand and enhance the attendee experience. Turns out I have a “beautiful” elbow and yes, some of you beginners are pressing too hard.

Parreco scan

Sonographer Haylea Weiss scanning Jamie Parreco’s ankle.

As I had my second joint scanned, I thought, what a cool experience; my body is going to help advance the safe and effective use of ultrasound. I found myself offering to volunteer any chance I could, having my elbow, ankle/foot, and shoulder scanned in the end. I listened, watched, and learned as attendees explored.

So why am I telling you this? As a program/meeting planner, it was valuable for me to see things from a model’s perspective:Parreco ankle scan

  • You really should wear comfortable clothes.
  • Gel really will get all over you.
  • Talking to the attendee can help them learn.

 

Here at the AIUM, we offer great opportunities for models to get involved at our annual meeting and courses, but for those of you who have not gotten on one of those exam beds as a model in a while, I encourage you to do so. Everyone learns on that bed; ultrasound grows on that bed; your future sonographers and physicians need you on that bed.

We have a unique opportunity to provide true hands-on experience in our field and I encourage you to support that in any way you can. Who knows, you may learn a thing or two about your body as well. #snappinganklevictim

 

Have you ever been a model for a hands-on ultrasound course? Share your experience below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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Jamie Parreco is Director of the Events and Continuing Education Services department at the AIUM in Laurel, Maryland.

Pioneering Ultrasound Units

If you think your ultrasound machine is out-dated, imagine if you still had to use these from as long ago as the 1940s. 

1940s

Ultrasonic Locator
Dr G. D. Ludwig, a pioneer in medical ultrasound, concentrated on the use of ultrasound to detect gallstones and other foreign bodies embedded in tissues. During his service at the Naval Medical Medical Research Institute in Bethesda, Maryland, Dr Ludwig developed this approach that is similar to the detection of flaws in metal. This is A-mode in its operation and was Dr Ludwig’s first ultrasonic scanning equipment.

Locator

 

1950s

Ultrasonic Cardioscope
Designed and built by the University of Colorado Experimental Unit, the Cardioscope was intended for cardiac work.

Ultrasonic Cardioscope

 

1960s

Sperry Reflectoscope Pulser / Receive Unit 10N
This is an example of the first instrument to use an electronic interval counter to make axial length measurements of the eye. Individual gates for the anterior segment, lens, and vitreous compartment provided accurate measurement at 10 and 15 MHz of the axial length of the eye. This concept was the forerunner of all optical axis measurements of the eye, which are required for calculation of the appropriate intraocular lens implant power after cataract extraction. This instrument, which includes A-mode and M-mode, was developed by Dr D. Jackson Coleman and Dr Benson Carlin at the Department of Ophthalmology, Columbia Presbyterian Medical Center.

Sperry Reflectoscope Pulser

 

Sonoray Model No. 12 Ultrasonic Animal Tester (Branson Instruments, Inc.)
This is an intensity-modulated B-mode unit designed exclusively for animal evaluations. The instrument is housed in a rugged aluminum case with a detachable cover that contains the cables and transducer during transportation. The movable transducer holder on a fixed-curve guide was a forerunner of mechanical B-scan ultrasonic equipment.

Sonoray Animal Tester

 

Smith-Kline Fetal Doptone
In 1966, pharmaceutical manufacturer Smith Kline and French Laboratories of Philadelphia built and marketed a Doppler instrument called the Doptone, which was used to detect and monitor fetal blood flow and the heart rate. This instrument used the continuous wave Doppler prototype that was developed at the University of Washington. 

Smith Kline Fetal Doptone

 

Smith-Kline Ekoline 20
Working in collaboration with Branson Instruments of Stamford, Connecticut, Smith-Kline introduced the Ekoline 20, an A-mode and B-mode instrument for echoencephalography, in 1963. When B-mode was converted to M-mode in 1965, the Ekoline 20 became the dominant instrument for echocardiography as well as was the first instrument available for many start-up clinical diagnostic ultrasound laboratories. The A-mode was used in ophthalmology and neurology to determine brain midlines.

Ekoline 20

 

University of Colorado Experimental System
Developed by Douglas Howry and his team at the University of Colorado Medical Center, this compound immersion scanner included a large water-filled tank. The transducer moved back and forth along a 4-inch path while the carriage on which the transducer was mounted moved in a circle around the tank, producing secondary motion necessary for compound scanning. 

Compound immersion scannerCompound immersion scanner tub

 

1970s

Cromemco Z-2 Computer System (Bioengineering at the University of Washington)
This color-Doppler prototype, introduced in 1977, was the computer used for early color Doppler experiments. Z2 “microcomputers” were used for a variety of data acquisition and analysis applications, including planning combat missions for the United States Air Force and modeling braking profiles for the San Francisco Bay Area Rapid Transit (BART) system during actual operation.

Cromemco Z-2 Computer System

 

ADR-Model 2130
ADR of Tempe, Arizona, began delivering ultrasound components to major equipment manufacturers in 1973. Linear array real-time scanners, which began to be manufactured in the mid-1970s, provided greater resolution and more applications. Grayscale, with at least 10 shades of gray, allowed closely related soft tissues to be better differentiated. This 2-dimensional (2D) imaging machine was widely used in obstetrics and other internal medicine applications. It was marketed as an electronic linear array, which was faster and more repeatable without the need for a water bath as the transducer was placed right on the skin.

ADR Model 2130

 

Sonometrics Systems Inc, NY BR-400V
The first commercially available ophthalmic B-scanner, this system provided both linear and sector B-scans of the eye. The patient was examined in a water bath created around the eye by use of a sterile plastic ophthalmic drape with a central opening. Both A-scan and B-scan evaluations were possible with manual alignment of the transducer in the water bath. The instrument was developed at the Department of Ophthalmology, Columbia Presbyterian Medical Center by Dr D. Jackson Coleman, working with Frederic L. Lizzi and Louis Katz at the Riverside Research Institute.

Sonometrics Systems Inc, NY BR-400V

 

Unirad GZD Model 849
Unirad’s static B-scanner, allowing black-and-white anatomic imaging, was used with a scan arm and had similar controls as those used today, including processing, attenuation compensation, and gain.

Unirad GZD Model 849

 

1980s

American Flight Echocardiograph
This American Flight Echocardiograph (AFE) is a 43-pound off-the-shelf version of an ATL 400 medical ultrasonic imaging system, which was then modified for space shuttle compatibility by engineers at the Johnson Space Center to study the adaptations of the cardiovascular system in weightlessness. Its first journey to space was on the space shuttle Discovery in 1985 and its last on the Endeavour in 1992. The AFE generated a 2D cross-sectional image of the heart and other soft tissues and displayed it in video format at 30 frames per second. Below, Dr Fred Kremkau explains more about it.

 

To check out even more old ultrasound machines, visit the American Institute of Ultrasound in Medicine’s (AIUM’s) An Exhibit of Historical Ultrasound Equipment.

 

How old is the ultrasound machine you use now? What older ultrasound equipment have you used? Did it spark your desire to work with ultrasound? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

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The AIUM is a multi-disciplinary network of nearly 10,000 professionals who are committed to advancing the safe and effective use of ultrasound in medicine.