Montgomery College - Diagnostic Medical Sonography

Week 14 Renal Ultrasound by Jessica

2010-11-27T21:25:00.011-05:00

HISTORY:
This is a 35 year old female who has been diagnosed with hyperparathyridism.

Please discuss the images, causes, treatments, prognosis, and any other information you find pertinent.

Week 13 Ob case study review by Evgeniya

2010-11-16T19:58:00.011-05:00

Patient History: This is 33 Year old female. G3P2. 1st trimester Ob ultrasound performed. By today ultrasound is 10wk 5d viable fetal pole seen, with heart beat 182 bpm. Following are images:

Image #1

Image # 2

Image #3

Image #4

Image#5

Comments: Patient has heavy bleeding. US exam show viable fetal pole. Please look carefully at the image and explain why it is bleeding. What cause it? What are the consequences?

Week 12 ABD Case Study Review by Hye

2010-11-14T15:12:00.007-05:00

Patient History: A 40 year male patient who had fatigue, headaches, weight loss, nausea, and appetite loss came for abdominal ultrasound exam. The patient had diabetes and high blood pressure.

Images:

Image #1

Image #2

Image #3

Image #4

Image #5

Description: The right kidney was 10.8x4.7x5.4cm, and the left kidney was 10.8x5.4x5.8cm. The patient's both kidneys showed increased echotextures. No evidence of renal stones or hydronephrosis was found. What is your opinion?

Wk 11 Blog 2 Case Review by Nancy

2010-11-11T20:40:00.004-05:00

Patient History: A 23 yo female sent from her vertility clinic for complete pelvic exam and salpingogram. Pt having difficulty with pregnancy attempts. Your thoughts?

Week 11 Case Study by Nancy

2010-11-07T18:54:00.004-05:00

36 yo female from the ER with vaginal bleeding and cramping. Pt states positive home pregnancy and she is undergoing IVF. She is AMA, GR-3, P-1, ab-1.

Pt had a CT earlier reporting a structure in rt adnexa.

Sonographic findings: No evidence of IUP, empty uterus

Rt and Lt ovary measurements WNL

What is the structure in the rt adnexa?

Week 10 ABD case study review by Flore

2010-11-02T10:41:00.005-04:00

Case Review: This is a 45 year old female who was referred to my clinical site today for renal ultrasound due to the presence of blood in her urine. there were an incidental finding during my exam and the patient was asymptomatic. here are some of the images.

image1 this is a sag view and patient lie supine

image2 this is a trv view

image3 this is a decube sag view note the location has change

image4 this is a CBD measurement with Doppler

Comment: there were a negative murphy's sign; what do you think this may be? why is the patient asymptomatic? what can be the complication of this finding and what are the treatment
options if patient become symptomatic? add any comment you think may be interesting.

Week 10 Case Study Review by Leah

2010-11-01T21:24:00.014-04:00

An 11-yr old girl presents with portal hypertension and elevated BUN lab values. She has had an abdominal ultrasound scan at least twice a year, for the past four years. Her older sister also came into the department to have an abdominal ultrasound scan. Linear, high-frequency transducers were used for some organs for a closer look, providing better resolution.
*Please comment on any abnormalities, prognosis, and treatment.

Image #1 Transverse Right Liver

Image #2 Transverse Left Liver

Image #3 Linear Liver

Image #4 Linear Liver

Image #5 Sagittal Spleen with Kidney

Image #6 Sagittal Left Kidney with measurement

Image #7 Linear Left Kidney

Image #8 Sagittal Right Kidney

Image #9 Sagittal Right Kidney with measurement

Image #10 Linear Right Kidney

Week 9 Case Study by Mimi

2010-10-26T21:29:00.013-04:00

Presentation:

A 23 years old primagravida presented for routine sonographic scan with no significant complaints. According to the patient, menstrual age was approximately 30 weeks.

Image 1:
MR image confirms the presence of a high-riding third ventricle (arrow), pointed parallel anterior horns, and dilated occipital horn (colprocephaly).

Image 2:

Transverse sonogram of the fetal brain shows dilation of the occipital horn (curved arrow) and a high-riding third ventricle (arrow).

Image 3

Image 4: Axial fetal cranium

There is prominence of the ventricles but more in the occipital horns.

Image 5: Oblique fetal cranium

Image 6: long axis fetal femur

Image 7: long axis fetal femur

Image 8:

Another MR image shows wide divergence of the frontal horns and elevation of the third ventircle.

Comment:

There are two different diagnoses to this case. Visualization of the cavum septum pellucidum is absent in the fetal brain. There is an association with chromosomal disorders such as trisomy 18, holoprosencephaly, etc. of the fetal head. The fetal bone images represent a genetic disorder.

Week 9 OB Case Study by Tia

2010-10-24T13:46:00.003-04:00

Case Review: 32 year old female with viable singleton IUP dating 17w6d per LMP. Patient referred to perinatal specialist due to abnormal anatomy scan at OB/GYN. Patient was late to prenatal care, today being her first ultrasound during this pregnancy. G2P1, with healthy 5 year old son. Nothing abnormal with previous pregnancy. No pertinent maternal or family history.

Images:

Image #1: SAG fetal spine (where is the cervical spine??? It’s on a different plane…YIKES)

Image #2: Coronal/ left fetus

Image #3: SAG midline fetal profile/thorax

Findings: U/S shows large anterior midline thoraco-abdominal wall defect with ectopia cordis and large ompahlocele. The spine has the appearance of severe scoliosis and extreme curvature in the thoracic portion, suggesting kyphosis. The amniotic fluid is quite generous at 26.4cm. The umbilical looked extremely short, but precise length measurement could not be obtained. Fetus showed little to NO movement. Follow up MRI confirmed the following:
1. Kyphoscoliosis
2. Ectopia cordis,
3. Polyhydramnios
4. Large omphalocele (containing liver, stomach, spleen, and almost all of the bowel) By MRI, omphalocele appears to be contiguous with the uterine wall (This is a very important finding that could not be determined with Ultrasound).

Previous to MRI, the diagnosis was suspected to be Pentralogy of Cantrell, but the supplementary MRI has led to a different diagnosis…. (Hint: Actual diagnosis is often a differential for Pentralogy of Cantrell)

Week 8 GYN Case Study by Abby

2010-10-19T23:29:00.008-04:00

Case Review: This is a case of a 43 year old female who was referred to my clinical site for evaluation of her uterus and ovaries prior to a hysterectomy surgery. She is G3 P3, and had a cesarean section performed for all of her pregnancies. Her LMP was 9/8/2010 (she came in for the study around 10/5/2010). She did not complain of any symptoms.

Images:

Image 1: SAG UTERUS with the bladder seen at the edge of the screen, inferior to the uterus. The anechoic structure is shown evaluated later on in the study.

Image 2: SAG UT with measurements. Calipers were placed at the best approximations of the organ borders.

Image 3: TRV UT seen with the endometrial stripe and other labeled structures.

Image 4: A measurement in SAG.

Image 5: Left ovary in SAG.

Image 6: Right ovary in SAG with color flow.

Image 7: Transvaginal image. Incidentally, the uterine position has changed from the transabdominal study.

Image 8: A transvaginal image of the anechoic structure seen earlier transabdominally.

Image 9: Seen with Doppler evaluation.

Image 10: Seen with further Doppler evaluation.

There are at least three findings with this case study. Please post a description of any impressions you have from the images shown, which may include observations of both the normal and abnormal. You may suggest pathologies that could be suspected based on these and the patient history, as well as any other issues that may be of concern. Thanks for looking! -Abby

Week 7 - OB Case Study by Alexia

2010-10-09T19:29:00.016-04:00

Clinical History: 38 year old female presents with pain. LMP is 6/5/2010.

Images:

Image #1:
Fetal Head 1

Image #2:
Fetal Head 2

Image #3:
Fetal Abdomen 1

Image #4:
Fetal Abdomen 2

Image #5:
Femur

Image #6:
Uterus

There is a single, viable, intauterine fetus in variable position of approximately 17 weeks 4 days. The fetal heart rate is 152. The placenta is anterior fundal.

There are 4 pathologies in this case. 2 can be classified as 1 pathology by textbook definition.

I hope you find this case as interesting and challenging as I did.

WEEK 6 OB CASE STUDY BY ZOULIATH

2010-10-05T20:23:00.002-04:00

PATIENT HISTORY: IT IS A 23Y OLD PATIENT G5 P5 WHO CAME FROM THE ER FOR PELVIC PAIN MOSTLY ON THE LEFT SIDE AND CRAMPING. NO BLEEDING. THE B HCG WAS POSITIVE. THEY SEND HER TO OUR FLOOR TO CONFIRM PREGNANCY.

IMAGE 1:

PICTURE 2: TRANSVERSE UTERUS BELOW GESTATIONAL SAC

PICTURE 3
PICTURE 4
PICTURE 5
PICTURE 6
PICTURE 7

HINT: WE DISCOVER 3 DIFFERENT FINDINGS WITH HER PREGNANCY.

WHAT DO YOU THINK.

Week 5 Transvaginal case study review by Kermen

2010-09-28T20:27:00.005-04:00

Patient history: A 45 year old female presented with complaints of pelvic discomfort and menorrhagia. The patient is on long term Tamoxifen therapy for breast cancer. A transvginal exam was performed.

Image 1: Sag Ut Mid

Image 2: Sag Ut Mid

Image 3: Sag Ut Mid

Image 4: 3 D

During transvaginal exam a thickened endometrial lining was documented (1.78cm).
Later on a sonohysterogram was performed, it revealed hyperechoic vascular ( 2.80 x 1.17 x 1.62 cm) mass, a single vessel was seen.

Week 4Liver case study review by Irene

2010-09-19T22:13:00.007-04:00

Patient History: A 61 year old male presented with complaints of abdominal discomfort and digestion irregularity. A complete abdomen was performed to rule out gallstones.

Images:

Image1: Sag lt liver

Image 2: Sag lt liver

Image 2: sag Rt liver

Discussion. The above images show a hyperechoic solid mass seen near the the Left Portal vein measuring 1.0x1.2x1.5cm . Color Doppler was used to show the mass increased vascularity. Also seen are multiple echogenic vessel walls scattered throughout the liver.

Week 3 Ob/Gyn Case Study Review by Grace

2010-09-09T10:50:00.003-04:00

Patient History: A 22 years old woman who presented constant severe adnexal pain that was intermittently sharp and stabbing. Her last normal menstrual period had ended 3 weeks before.The patient had a similar episode 6 months ago which resolved spontaneously and diagnosed as musculoskeletal pain.

Images:

Image #1 Sagittal Rt Ovary

Image #2 Sag Rt Ovary-Color Flow

Image #3 Sag Rt Ovary- Doppler Duplex

Discussion: Based on the above 3 images, right ovary is enlarged and hypoechoic with multiple follicles along its periphery. Also, Color Doppler is shown reduced venous return from the ovary. It is result of stromal, edema, or internal hemorrhage or mass.

Upcoming event in Dec!

2010-09-07T21:41:00.009-04:00

Refresh your knowledge of

ultrasound physics and instrument !

SONOGRAPHY

PRINCIPLES AND INSTRUMENTS-
FUNDAMENTALS AND ADVANCED

Presented by Frederick Kremkau, PhD

December 4-5, 2010

Montgomery College, Takoma Park, Maryland

Objective

Explain how the pulse-echo principle applies to sonography
Describe the anatomic image formats used in sonography
Explain how ultrasound transducers work
Describe the major parts and functions of sonographic instrument
List imaging artifacts that can occur in sonography
Explain the risk and safety issues in sonography
Describe how the Doppler effect is applied in sonography
List the ways in which Doppler information is presented
Explain how aliasing occurs and how it is corrected

Who can attend?

The course is designed to meet the needs of sonographers and physicians of any

speciality and all levels of experience, beginners to advanced

How to register:

Online: www.aium.org
Fax: 301.498.4450
Mail. American Institute of Ultrasound in Medicine

Postgraduate Courses:
December 2010
14750 Sweitzer Ln. Suite 100
Laurel, MD 20707-5906 USA

Questions? Call the AIUM Professional Development

Department at 800. 638.5352 or 301.498.4100

Week 2 - Thyroid Case Study Review by Linda Zanin

2010-09-07T10:48:00.009-04:00

Patient History: A 55 year old female presents with complaints of gastroesophageal reflux, crampy abdominal pain, depression and osteoporosis. Laboratory results showed a persistently elevated PTH levels.

Images:

Image 1 - Sagittal

Image #2 Transverse

Image #3 Sagittal with Color Doppler

Discussion:

The images presented demontrate a solid nodule on the right lobe of the thyroid that demontrates vascularity with color Doppler.

upcoming event in June!

2010-03-26T07:57:00.004-04:00

Sonography

Registry Review

June 5, saturday

Montgomery College

Takoma Park, MD

Learn and Prepare for ARDMS registry examination!

objectives

able to demonstrate an understanding of ultrasound physics and instrumentation

able to discuss the sonographic appearance of normal findings and pahology in the specialities

take a computer-based pre- and post test to evaluate weaknesses and strengths

Who should attend?

The AIUM Sonography Registry review is designed for new sonography graduates prepare to take the ARDMS registry examination. It also will benefit to the experienced sonographers and vascular technologists who need to take registry test or wish to add a speciality

How to Register:

· Online: http://www.aium.org/
· Fax: 301-498-4450
· Mail: American Institute of Ultrasound in Medicine
Attn: Ultrasound Registry Review 14750 Sweitzer Ln, Suite
100 Laurel, MD 20707- 5906, USA
· Questions? Call 800-638-5352 o 301-498-4100
· If you need more information, visit http://www.aium.org/

New Innovations in Ultrasound Technology by Nancy

2010-03-26T07:48:00.002-04:00

Blog Posting by Nancy Hoxie
1st Year DMS Student
Montgomery College

New Innovations in Ultrasound Technology

At Washington University in St. Louis two engineers have been developing portable ultrasound capabilities that can be taken to underdeveloped countries or rural areas in America to assist in diagnosing health problems. For 25 years of research, engineers, William Richard and David Zar, have been taking technology that normally fits into a full sized cabinet and now miniaturizing this technology down a tiny card. The electronic board measures 1inch by 3 inches. About 10 years ago the engineers moved their work from developing a PCI card to USB plug in probes. Their focus of engineering moved to the electronics of the probe. So now when you want to change a probe you are using a USB device instead of having to change the card. Richard and Zar are now collaborating with Microsoft Research and have developed a number of commercial based USB probes that are compatible with Windows XP and Windows Vista. The probes can be used with compatible Windows Mobile Smartphone. The advantage of using the smartphone verses PC is that the smartphone is super portable and can be used as a platform to transmit images to another location using the smartphone internet capability.

Without a doubt this is extraordinary technology! But, what are the pros and cons? As I am reading about the proposed uses of the equipment all I am reading is about how this new technology can be made available to everyone. Will there be restrictions as to who will be allowed to purchase the ultrasound equipment? At the end of one article William Richard states that he hopes to see the probes on any pharmacy shelf soon. He hopes to have the cost down to approximately $500.00 a probe. GE has recently announced their version of a hand held ultrasound device, the Vscan, without any mention of price. GE also hopes to see the ease of availability for those that wish to purchase an ultrasound device; they even encourage the ease of home use for pregnancy scanning.I am currently in ultrasound training through an accredited program. I would hope that there will be some restriction on who will be allowed to buy this new ultrasound equipment. Those of us who are professionally trained and know the complexity of imaging and interpreting ultrasound are fascinated with the technology but at the same time I see some devastating circumstances occurring if it is left unchecked.

Do any of you see other pros and cons? What do you think would be the most likely error an untrained person would make? Do you think this will make office based ultrasound obsolete and why?

Travel Sonography: Is It a Vacation? by Abby

2010-03-26T07:46:00.002-04:00

Blog Posting by Abby Coffin
1st Year DMS Student
Montgomery College

Travel Sonography: Is It a Vacation?

On our steadily progressing journey through school, we have approached many new and exciting situations. But what about our journey after school? How should we land a job? Or rather, where?

One of the many options out there is travel sonography, an attractive option that boasts the ability to travel the country as well as see firsthand all different kinds of work environments. Exposure to new learning experiences as a sonographer could become invaluable for resume building by providing you the skills to face a diverse set of dynamic situations, an invaluable asset for you and potential employers. Company compensated accommodations and paid benefits in conjunction with potential exemption from Federal income taxes propose a modestly lucrative living on top of an exciting career path.

But what happens that morning when you wake up and realize you miss your husband and his chainsaw snoring, or you miss your hyperventilating Pug greeting you at the door? Maybe you’re homesick. It’s possible that a regular routine is what keeps you grounded, in which case travel sonography may not be the thing that blows your hair back. It could be that you have a well-established family and children in school, or other family obligations that require you to stay nearby. Would travel sonography be more of an emotional drain than a reward?

On the other hand, there are those who just bring everyone along - husband, kids, pets, and plants! Most assignments are about 13 weeks in length, or about 3 months, which can also have its positives and negatives. Some people enjoy being able to make many new friends but appreciate the ability to move on without too much separation anxiety or involvement in workplace politics. Others believe that traveling has allowed them to serve a deeper purpose by placing them in the right place at the right time for those in need – whether they were patients or coworkers. In all cases, traveling is a great way to explore various work sites and geographical locales, whether you are seeking the best place to settle down or you enjoy the occasional change of scenery.

There are many other considerations in choosing travel sonography, and if you are interested you should do a little research, ask around, and weigh your obligations and flexibilities. Would you consider traveling? Would you agree if your significant other wanted to travel and work? Do you know anyone who travels and can share their individual insights? What are some facts and myths about travel sonography that you have heard? What about international travel?

Reference and a great resource:
http://healthcaretraveler.modernmedicine.com

Diagnostic Medical Sonography as a Career: What is it About? by Mimi

2010-03-26T07:43:00.002-04:00

Mimi Tran Blog post
1st Year DMS Student
Montgomery College

Diagnostic Medical Sonography as a Career: What is it About?

Have you ever wondered about a career in medical sonography? You know those people that perform the studies when you go into a hospital for a sonogram of a baby or a study of your heart. Were you ever curious about the educational requirements, duties, certifications, salaries, locations, job outlook, etc...? Then read on.

Ultrasound technicians or sonographers are highly-skilled professionals who use specialized equipment to create images of the internal structures, organs and/or tissues inside the human body for the physicians to diagnosis medical problems. For over the last 20 years, these techs have usually been employed by clinics, hospitals, private practice physician offices, public health facilities, laboratories, and other medical settings.

Sonographers must meet certain requirements such as: be in good physical health condition, be able to lift over 50lbs, be able to analyze technical information, interact compassionately and effectively with the sick or injured, and obtain and record patient histories. They must also know the dangers of blood and bodily fluid exposure.

Salaries for sonographers are competitive with or higher than other professionals with similar levels of education. These vary according to experience levels and geographic locations. A release by the SDMS Salary and Benefits Survey reports (released March, 2005) that a sonographer’s median salary is $61,984, or typically $29 per hour.

A medical sonographers training may vary; some may train in hospitals, vocational-technical institutions, colleges or universities, or the Armed Forces. Colleges and universities offer formal training in either 2-year and 4-year programs, resulting in either an associate’s or a bachelor's degree. From what I can tell, these programs are a study and time intensive commitment, so do your research and be ready to jump in head first.

Medical sonographers are experiencing a growth rate of about 18% thru 2018, much faster than most similar occupations. This is due to a growing aging population, advancements in technology, and the need for a safer and more cost-effective alternative to radiological procedures.

Now that you understand more about the medical sonographer’s career, do you think that this is the career for you? Are you interested in exploring the accredited educational institutions with programs in diagnostic medical sonography near you? Do you know anyone who is already a registered diagnostic medical sonographer? What about someone who has been in other healthcare fields and is now moving to sonography? How did they think the different fields compared to each other?
Reference: http://www.sdms.org/career/career.asp http://www.medtravelers.com/ultrasound-technician.aspx

Ultrasoundn Practitioner by Grace

2010-03-26T07:41:00.001-04:00

Blog posting By Grace Lee
1st year DMS student
Montgomery College

Ultrasound Practitioner

In the 21st century, the change in the patient demographics, needs and health care finances improves quality in clinical practice. Moreover, the change develops health professions. Now, you can see many Nurse Practitioners and Physician’s Assistants who are specialized members within the health professions. They might stand as a good model for the Ultrasound Practitioner.
What is an Ultrasound Practitioner? According to The Ultrasound Practitioner, by Coffin, an Ultrasound Practitioner is a health care professional who autonomously performs and interprets ultrasound procedures in primary or specialty areas of ultrasound. In other words, the Ultrasound Practitioner is an advanced-level ultrasound imager or interpreter. The Ultrasound Practitioner would provide a much higher level of clinical performance, interpretation, clinical correlation and suggested follow-up.

To be an Ultrasound Practitioner, prerequisites are strongly suggested. There are many more requirements entering this profession to ensure “experience” in the field. For those who are already eligible for a Master’s program, you should prepare a prospective plan. There is a sample curriculum of an Ultrasound Practitioner program that has been created by George Washington University. For more information on their proposed curriculum you can visit the following url (http://www.sdms.org/pdf/UP2001.pdf, p5), or e-mail at them at ultrap@gwu.edu to inquire about their Master’s degree for Ultrasound Practitioners that is under development. The following requirements are currently recommended: Bachelor’s degree, Ultrasound Practitioner master degree core curriculum, 5 years clinical experience, RDMS, RDCS, RVT or CCI certified, post-graduate clinical training in Ultrasound Practitioner Program (18-24 months), successful completion of Ultrasound Practitioner national board certification examination.

So far, Ultrasound Practitioner programs do not exist. There are currently three universities who are in the process of developing a program. They soon will be updating their initiatives by reporting their progress through JDMS soon.

It will be challenging to become an Ultrasound Practitioner, however imagine being an Ultrasound Practitioner in the future as healthcare evolves; we hope that there will be a place for this new emerging profession. If you would like more information on becoming an Ultrasound Practitioner, please visit http://www.sdms.org/pdf/jdmsup.pdf or http://www.sdms.org/pdf/UP2001.pdf . This webpage will help answer your questions.

Reference
http://www.sdms.org/pdf/jdmsup.pdf
.
http://www.sdms.org/pdf/UP2001.pdf

State licensure for sonographers by Irene

2010-03-26T07:39:00.002-04:00

Blog Posting by Irene Ateh Niba
1st Year DMS student
Montgomery College

State licensure for sonographers

Did you know that sonographers are not required to be licensed to practice sonography across the United States today? Presently, graduates of sonography schools whether accredited or not can practice sonography statewide without state licensure in the United States. Many sonographers are registered with ARDMS and do have credentials but these credentials awarded by ARDMS do not have much legal weight. This is because there are no state laws or regulations implemented to oversee sonographers perform sonograms and sanction sonographers of inappropriate acts. With state licensure, physicians and consumers would be able to receive quality sonograms without unnecessary repetition and physicians would provide the best treatment decisions based on the correct information received from these sonograms. With state licensure, sonographers who did not acquire proper sonographic education or who commit inappropriate acts would be banned from practicing.

Two states (New Mexico and Oregon) out of all fifty states are now moving forward in requiring sonographers to get licensed. As of July 1st 2010, sonographers in Oregon are required to be licensed as well as sonographers in New Mexico. What example does this show to all other states? Are they going to follow New Mexico and Oregon footsteps to license every sonographer or sit back and not have to deal with it? What does this mean to sonographers in New Mexico and Oregon? Are they going to get licensed? Or move to another state to practice if licensure is impossible. What about the job market in New Mexico and Oregon? Will this attract sonographers from other states to NM and Oregon or would this drive away many sonographers who are trying to avoid state licensure?

There are pros and cons to state licensure but if a hairdresser can have a license to make hair, so too can a sonographer have a license to perform sonogram.

References

Benefits Of Your Sonography Certificate http://www.medacademy.org/articles/benefits-of-your-sonography-certificate
Oregon Governor Signs Sonographer Licensure Legislation and New Mexico Sonographer Licensure Law Signed http://www.sdms.org/

New Mexico Legislature Passes Bill To License Sonography and Magnetic
https://www.asrt.org/Content/News/PressRoom/PR2009/newmexicol090320.aspx

Ultrasound on a Smartphone by kermen

2010-03-26T07:36:00.002-04:00

Blog posting By Kermen Bormanshinov
1st year DMS student
Montgomery College

Ultrasound on a Smartphone

Most Americans at some point in their lives will have an ultrasound exam. The purpose of this exam is to evaluate one’s health. Mothers first experience ultrasound imaging during their pregnancies, monitoring the development of their fetuses. The machines are large and located in hospitals and physicians offices but now it is possible through rapid high-tech development that ultrasounds can be performed with a Smartphone.

Researchers at the Washington University of St. Louis, with help of a Microsoft grant, developed USB probes compatible with smart phones. It was an unbelievable step from bulky machines to small probes that can be used with cell phones. Researchers are sure that they will help a lot of people.

These ultrasound portable devices will make lives of so many patients much easier, like patients with Duchene's Muscular Dystrophy. The use of USB compatible probes with Smartphone’s will make ultrasound exams more accessible for a general population. I think using these devices in ambulance mobile units’ will save a lot of lives. They can also be used in combat for the military to help determine the seriousness of an injury. This technology could save a soldiers life not to mention the impact it will have on lower the cost of imaging for the general patient population.

The typical portable ultrasound device costs around $30,000. The USB compatible probes sell for less than $2, 000, with a goal price of $500, which makes them more affordable. These lower costs for this technology will be very beneficial in developing countries since two third of the world do not have imaging services because of the high cost and the lack of trained professionals. With this technology an ultrasound scan could be performed in a remote village and then images could be sent to a clinic for a diagnosis.

Do you think USB probes compatible with Smartphone’s will make larger more bulky ultrasound machines obsolete in the future? Do you think ultrasound in a Smartphone will dominate ultrasound imaging? What are the consequences of wide availability of these probes to a general population? Do you think they will find a wide application in our community? What do you think about your Smartphone becoming a medical imaging device?

References:
www.esciencenews.com
www.sonoworld.com
http://news.wustl.edu

The Advantages and Disadvantages of a Distance-Learning DMS Program by zouliath

2010-03-26T07:31:00.003-04:00

Blog posting By Zouliath Bouraima
1st year DMS student
Montgomery College

The Advantages and Disadvantages of a Distance-Learning DMS Program

Online blended learning is a requirement for all students enrolled in the Diagnostic Medical Sonography Program at Montgomery College. Some advantages of distance learning includes less time commuting. Our money and time that we will have spent on travel back and forth to school will be saving. We can complete most of the classes at our convenience. Most of the time, we don’t have to attend a lecture at a particular time and place. We can review the assignments and do our homework during off-hours or from home. We also have the flexibility to study in any convenient location with an Internet connection. We can study wherever we have access to a computer and Internet connection. We also have the flexibility to join conversations in the board discussion areas at any hour, and to review our classmates' comments since the previous visit.

Distance learning also makes us gain extra knowledge on computer skill, and how to manage our time. Distance learning is a self-paced learning for slow and quick learners. It reduces our stress and increases our satisfaction.
Distances learning also has its disadvantages, such as both the instructors and students involved in distance learning may need to make sacrifices at times to get things done on time. Distance learning does not offer immediate feedback. Distance learning does not always offer all the necessary courses online. Students pursuing a specific degree program such as sonography, will have to go to their clinical sites to learn how to scan, this cannot be completed online. Some people find it hard to manage their time by themselves and study without supervision. Social isolation is another disadvantage of distance learning because studying can be more isolated.

Based on your unique circumstances, you can compare the advantages and disadvantages of distance learning over traditional learning and decide which one is right for you. A few years ago, distance education was seen inferior but nowadays all colleges are providing distance learning courses and it is generally considered a way to learn and improve one's life.

Contrary to what many people believe, the distance education advantages far more outweigh the distance education disadvantages. Do you agree?

Do you think that sonography will be much easy if it was not a distance learning course?

How do you manage your time to submit all assignments on time?

Do your really have more time to spend with your family when you are doing distance learning class?

References:http://www.distance-learning-college-guide.com/index.htmlhttp://www.montgomerycollege.edu/distance/media/distancelearning.swf (video)

Do you really know what we should about bioeffects?

2010-03-26T07:23:00.002-04:00

Blog posting By Jessica Farrow
1st year DMS student

Montgomery College

Do you really know what we should about bioeffects?

As professionals, diagnostic medical sonographers keep abreast on new and current issues, but how often do they renew their understanding on topics that affect them and their patients on a daily basis?

The ultrasound machines used every day, have greatly improved over the past ten years. They have more diagnostic capabilities and applications. The main reasons for these improvements have been the permission from the FDA, in 1992, to allow higher acoustic intensity limit (720 mW/cm2), in addition to technological advancements.

We are all happy for these improvements but with improvements to our machines come more experiments on bioeffects. It is our responsibility to maintain the excellent safety record of diagnostic medical sonography. The only way we can do this is to reeducate ourselves by reading new studies and by learning how to use our equipment in the safest and most efficient way.

Unfortunately, a recent study conducted by Sheiner, MD, Shoham-Vardi, PhD, and Abramowicz, MD, showed only 15.9 % of physicians and 14% of other end users, Including sonographers, knew where to find the TI (Thermal Index) and MI (Mechanical index) during an ultrasound examination, When both of these values are located in the upper right hand side of the display screen.

These values should be monitored after each scanner adjustment for all patients especially during fetal scans. Even though a temperature elevation of 2 degrees Celsius above normal exposure for less then fifty hours has no confirmed bioeffects reported, we should still operate under the ALARA (As Low As Reasonably Achievable) principle to ensure our patients safety. To use the ALARA principle effectively, decrease the out put power and increase the amplification enough to still get an optimal image.

The Thermal index (TI) in prenatal examinations should not exceed 0.5 in the first trimester. If the TI is greater than 0.5 to 1.0 the time frame sound not exceed thirty minutes, and TI values grater than 2.5 should not be used for more then 1 minute. Use a mechanical index (MI) less than 0.4 when gas bodies are present such as fetal lungs.

In postnatal examinations, try to keep the TI under 2.0 but can go up to six for scans under thirty minutes. Limit scan time for TI over 6 to one minute. Use a mechanical index less then 0.4 if gas bodies are present and can go up to 1.9 (FDA Limit) if gas bodies are not present. These values can also be used for adult patients. The TI and MI can be increased in order to complete an effective study but it is always good to keep in mind the safest levels of TI and MI.

The AIUM reports that there are currently no harmful bioeffects according to ultrasound exposure reports. However, some bioeffects may be a concern in the future, but at this point, the benefit of ultrasound is far greater then the risk, as long as the machinery is maintained and operated by trained and competent individuals who use the power of ultrasound prudently.

Do you know where to look to determine if you are scanning to find the Thermal Index and Mechanical Index for the exam you are performing? Would you know what to do to decrease the output power? Think about ALARA the next time you are scanning.

Resources:

“Sonography Introduction To Normal Structure And Function” Second Edition: Curry, Tempkin :Elsevier, 2004: (Page 22)

“Understanding Ultrasound Physics” Third Edition: Edelman, Ph.D : ESP, Inc, 2007 : (page 369-382)

Ultrasound Biosafety Considerations for the Practicing Sonographer and SonologistNelson et al. J Ultrasound Med.2009; 28: 139-150

J Ultrasound Med 200/;26:319-325

New Technology by Evgeniya

2010-03-26T07:14:00.003-04:00

blog posting By Evgeniya Lepchenko

1st year DMS student

Montgomery College

New Technology: Introducing Vscan Pocket-sized Visualization Tool for Ultrasound

GE Healthcare introduced Vscan, a new, pocket-sized visualization tool developed to provide physicians with imaging capabilities at the point-of-care. Roughly the size of a smart phone, Vscan houses powerful, ultra-smart ultrasound technology that provides clinicians with an immediate, non-invasive method to help secure visual information about what is happening inside the body.

The unit weighs one pound and is only 3 inches wide and 5.3 inches long, offering both standard black and white imaging, as well as Doppler colored blood flow. GE is touting Vscan's size and capabilities for cardiologists, and for primary care physicians, as well as OB/GYN, ER, and others, to scan the liver, kidney, aorta and peripheral vessels, babies and anything else the transducer can penetrate.

Many in the industry hope that this device offers a chance for physicians to make a move from stethoscopes to portable imaging devices, bringing advanced visualization to any examination room. The ability to take a quick look inside the body using Vscan may help clinicians detect disease earlier. For example the patient who comes in and has a bounding abdomen and doctor might set that transducer down and see that there's a very large aortic aneurysm.

Although the device is pricy, up to $10,000 it has good features like Intelligent workflow enhancements, battery charger station and battery life of one hour of scanning, which is good for up to 30 patients based on an average of 2 minutes per scan, voice annotation, USB docking station Link to a PC for organization and export of data, gateway software with services tools and remote diagnostics. Vscan was utilized at the Mobile Medical Unit, at the Vancouver 2010 Olympic Winter Games.

The Vscan imaging device received 510(k) clearance in the U.S. by the Food and Drug Administration (FDA), the CE Mark by the European Union, as well as the Medical Device License from Health Canada and is now commercially available in the U.S., Europe, India and Canada.

What do you think of this new technology, does it serve a purpose? Let me here what you think.

Resources:
http://newsroom.gehealthcare.com/_uploads/docs/vscan_press_release.pdf
http://medgadget.com/archives/2010/02/ges_vscan_worlds_smallest_portable_ultrasound_now_available_worldwide.html
http://marketplace.publicradio.org/display/web/2010/02/15/am-ultrasound-tech/
http://www.earthtimes.org/articles/show/ge-healthcare-introduces-vscantrade-pocket-sized-visualization-tool-for-point-of-care-imaging,1164307.shtml

Sonography and Staying Healthy by Tia

2010-03-23T19:22:00.010-04:00

Blog posting By Tia
1^st year DMS student
Montgomery College

Sonography and Staying Healthy

Staying physically and emotionally healthy is vital for the sonographer and their patients when working in ultrasound. It is important to use prophylactic measures to prevent physical and emotional injuries in the workplace. It is also very important to recognize the symptoms of oncoming physical injuries or emotional distress so that we may be proactive in getting the help we need before it’s our work is affected negatively.

There was a study conducted in 2008 to determine the occurrence of physical injury in the field of sonography. It was found that 90% of the study participants were scanning with significant pain. The study also showed that after 2 years of scanning in pain, 14% of these participants had to change their profession due to job related injury (exact number of participants not disclosed). I’m not sure about everyone else, but I do not want to be one of those techs scanning in pain, and I certainly do not want to have to change professions due to injury. It is HARD work to become a sonographer, so we need to start practicing proper ergonomic techniques NOW to prevent work related injuries and job changes.

Musculoskeletal injuries are most often caused by the following motions with scanning: excessive use of the same muscles, frequency of repetitive motions, duration of load on tendons and muscles, level of muscular effort, and insufficient recovery time. When I saw this list of things that cause injury I thought, “Yeah, but these are the motions that are expected of me while scanning. How am I supposed to prevent injury and still do the job that I am hired to do?” There are simple things that we can do to prevent unnecessary strain our muscle and joints. When standing we should maintain a neutral body position. Did you know that standing in neutral body position will apply 112 pounds of compression on your spine, while standing with a 40 degree forward bend will apply 225 lbs of compression on your spine? Just standing correctly will relieve spinal pressure. It is also very important to make sure the bed and your chair at appropriate heights for your scan. If you are feeling tired, take a break or sit down during a scan you may normally stand through. Maintain an appropriate “reach zone” by having the patient move closer to you or have someone help you scan. Your health and, ultimately, your occupation are more important than acting completely self-sufficient and standing too much or reaching too far. Here is a link to a chart of ergonomic exercises that can be helpful in preventing multiple musculoskeletal injuries (http://www.medicalpositioning.com/products/images/articles/pdf/Ergonomic%20Guidelines.pdf ). I recommend we start using them now to stretch and strengthen those muscles we will be using recurrently in sonography

Stress is also a huge health factor that must be addressed in subject of sonography health. There is “eustress” which is positive stress and is what gives us our competitive edge. It is so important to keep our competitive edge and continue to push ourselves to work harder and do better. It is when we become “distressed” that our performance begins to suffer. We may not even notice our work suffering, but it may be noticed by those that are working with us. When we begin slacking in the workplace, as unintentional as it may be, our co-workers have to work harder to make up the slack. This can give rise to resentment in the workplace. To prevent this downhill spiral, here are some warning signs of excessive distress: Changes in mood or personality, changes in sleep patterns, lethargy, low energy levels, antisocial behaviors, and changes in appetite. If you begin to see changes in yourself, such as the ones discussed above, don’t ignore it. It is important for us to assess our lives every once in a while. Are you working too much? Are your hours too long? Is the combination of work and home responsibilities bogging you down? Maybe you just need to take a break, do something different this weekend. If you are feeling distressed and feel like there is no way out, maybe you should consider talking to someone about it. Sometimes just knowing someone understands how you feel lifts the weight a little bit. Do what is best for you!!! No job is worth debilitating physical or mental pain.

Sources:

http://www.medicalpositioning.com/products/images/articles/pdf/Ergonomic%20Guidelines.pdf

http://www.mind.org.uk/help/diagnoses_and_conditions/early_signs_of_mental_distress

“Lecture: Hidden Hazards: Injury Risks in Sonography”, video lecture, www.sonoworld.com, Carolyn Coffin, MPH, RMS, RVT, RDCS.

How to avoid musculoskeletal injuries by hye

2010-03-14T17:41:00.003-04:00

By Hye Lee

1^st Year DMS Student

Montgomery College

How to avoid musculoskeletal injuries

Many people think that sonography is an easy procedure to perform because they only see a sonographer holding a transducer, which is small and light, taking pictures by pressing buttons, a little bit of typing, or telling a patient to take a big breath. However, that is not true. One of the biggest obstacles that sonographers encounter at the workplace is musculoskeletal injuries (MSIs). MSIs are caused from minuscule and cumulative trauma to human tissue. Sonographer’s experience pains in common body parts; upper and lower back, neck, shoulder arms, and legs. Bursitis, thoracic outlet syndrome, tendonitis, tenosynovitis, carpal tunnel syndrome, plantar fasciitis, and tarsal tunnel syndrome may be caused by repetitive activities throughout the day. Studies have shown that a frequent source of muscle fatigue and potential injury exists whenever low levels of muscle contraction must be maintained for a long duration. These are the exact body movements that sonographers perform while scanning. Even though the sonography community acknowledges the importance of ergonomics, which makes a safe working environment, MSIs cannot be prevented by ergonomics alone. There should be other approaches to prevent these job-related injuries.

MSIs are has multiple causes. Most sonographers experience pain in their neck, back, shoulder, wrist, hands, fingers, and feet. The main causes of body pain result from poorly designed ultrasound equipment and stretchers, improper body mechanics while scanning, prolonged procedure, insufficient rest or breaks, and repetition of the same type of study for a long periods. Knowing the causes of MSIs is very important because it shows how to reduce and prevent these injuries.

Nowadays many ergonomically designed ultrasound machines have been developed. However, ultrasound machines are so expensive that buying a better version of them whenever a new product is on the market is impossible. Moreover, most outpatient radiology practices use fixed exam tables. As a result, uncomfortable and stressful postures are used while performing the many different types of ultrasound exams. If a bed cannot be adjustable, a chair should be adjusted to provide a more convenient and safe work environment. Remember that adjusting a chair takes several seconds at most, but the pain from awkward body posture stays far longer and may rupture your weakest tendons in your body. In addition, proper room arrangement enables can help eliminate both unnecessary exam time and extra body movements for each procedure. Placing frequently used items such as drape papers, gel bottles, gloves, pillows, towels, and chairs near the ultrasound machine is also helpful to reduce MSIs.

Maintaining good body mechanics is critical to prevent muscular injuries. Sonography requires various movements such as pushing, pulling, picking up, holding, standing, and walking, etc. Because ultrasound machines are very heavy, sonographers should be cautious whenever they pull or push a machine. Slightly bending arm position reduces shoulder and back injuries when moving ultrasound equipments. Bending the legs instead of bending at the back is necessary whenever picking up or putting back exam pillows, drape papers, or probes. Positioning the feet shoulder wide apart while standing is also a good way to maintain proper whole body alignment. Lightly gripping the transducer lessens unnecessary wrist tension. Instead of leaning over the patient, ask the patient to move closer to the sonographer to reduce back pain. Being aware of good body mechanics as much as possible will keep sonographers from developing MSIs.

Taking a short break between scanning is also effective in reducing MSIs. Simple and short stretches, even 5- 10 seconds, for the neck, shoulders, back, and legs will lessen and prevent repetitive strain injuries. Stretches as a ritual after two or three exams are an effective way to increase blood circulation of that body part and to decrease chances of MSIs. Not only at work but also at home, MSIs prevention activities can be performed to prevent muscle injuries and strengthen muscles in the body. The stronger the muscles, the less muscle injuries there will be.

Sonography is a complex process which requires repetitive muscle movements numerous times a day, a week, a month, and a year. To accomplish this multi tasks continuously without musculoskeletal injuries, various preventive components should be considered and performed every day. Ergonomic environments, a good body mechanics, regular exercises, and a balanced diet work together to protect the body from work-related injuries of sonographers.

What would you do to reduce your risks of MSIs?

References

Craig, Marveen. Essentials of Sonography and Patient care. 2nd ed. St. Louis;Sounders. 2006. pp. 55-73.

Donatelle, Rebecca. Health The Basics. 8^th ed. New York; Prarson. 2009. pp. 250-286, 320-345.

Pryor, Esther & Minda Goodman Kraines. Keep Moving. 4^th ed. Mountain view; Mayfield Publishing Company. 2000. pp.65-77.

Reece, Campbell. Biology. 7^th ed. New York; Pearson. 2005. pp. 39-53, 141-157.

Baker,J.P. & S.L. Murphey. Ultrasoud Ergonomics. hppt://www.sdms.org/pdf/ergowhitepater.pdf. Retrieved 2/28/2010.

Just When You Thought You Were Out Of The Woods by Alexia

2010-03-07T21:52:00.007-05:00

By Alexia Park

1st Year DMS Student

Montgomery College

Just When You Thought You Were Out Of The Woods

Do you remember when you just finished Sonography school and felt a huge sigh of relief? Do you remember when you passed the physics board and then received your credentials? Guess what? You are not out of the woods. As many sonographers are aware, one must obtain Continuing Medical Education (CME) credits periodically to maintain their credentials. In the near future, however, the three credentialing bodies will require sonographers to obtain recertification. Specifically, the three entities are as follows: American Registry for Diagnostic Medical Sonography (ARDMS), American Registry of Radiologic Technologists (ARRT) and Cardiovascular Credentialing International (CCI).

Specific details of the recertification process will be announced in early 2010. What is anticipated is an affordable, user-friendly, computer based examination that practicing sonographers should not have any problems successfully passing. Many can breathe a huge sigh of relief as there will be no physics on the exam.

One exception to this rule is that “unlike ARDMS and CCI, ARRT will not require current registrants to be recertified….only those who become certified in 2011 and after will face recertification requirement including retesting.” Orenstein, SDMS News Wave, pg. 2, December 2009

This author feels that recertification is a positive step in the right direction as sonography is a constantly changing, fast-paced healthcare field. It is imperative that those who work in the field stay abreast of the latest innovations, precautions and techniques as taking care of the patient must be the first priority and only by knowledge and skill can that be accomplished. However, it is inevitable that not everyone feels this way and many will protest the necessity for this requirement.

How does the upcoming new requirement to obtain recertification make you feel? Do you think it is a fair policy and will benefit the ultrasound practice as a whole and hold clinicians to a higher standard? Or, do you feel it’s just another way for the certifying entities to nickel-and-dime you? Do you feel confident in your abilities that taking an exam based on your skill should not be a huge obstacle? Or does the thought of a skills-based exam have you running for the hills?

Keepsake ultrasound by Flore Fonmi

2010-03-01T20:54:00.008-05:00

Blog posting By Flore Fonmi
1st year DMS student
Montgomery College

Keepsake Ultrasound

Now days there are many organizations that are opening up all over the United States in order to provide keepsake pictures and videos to the family regarding their unborn child. Even though it is exiting to have an idea of how a baby will look like before it is born, there are many questions that are raised as to whether or not keepsake ultrasound should be allowed. Right now, according to the U.S. Food and Drug Administration (FDA), an ultrasound study should be ordered by a doctor for a medical reason and performed by trained credential sonographers or physicians. This is because there may be some misdiagnoses or misinterpretations that will not reflect the reality or the baby’s condition. Would you agree with this decision? Some organizations will tell us that they just want to make the parents happy or they want to reduce the cost of some mothers who will spend more money if they don’t know the gender of their unborn baby. In my opinion, I would not blame the parents for wanting to “see” their baby; however we have to think about the effect of exposing the baby to the high frequency sound waves, especially when the exam is not performed by a trained healthcare professional. According to the American Institute of Ultrasound in Medicine (AIUM), appropriate trained and credential healthcare professionals should be the only ones performing ultrasound on the patients. This is because they have been trained to recognize pathology and how to avoid over exposing the baby.

Do you think it is right to allow these organizations who promote keepsake ultrasound to continue their business? Do you have an opinion on whether keepsake ultrasound should be allowed?

Whether you agree or not, there are people who will continue to seek out getting keepsake pictures as long as they are being offered. If that is the case, these people should ask if the person performing the ultrasound study is a trained sonographer or healthcare professional qualified to perform ultrasound. Will they be able to inform a patient if something is wrong or relate any diagnostic problems to their physician?

References:
http://www.americanpregnancy.org/pregnancyhealth/commemorativeultrasound.html
http://www.aium.org/publications/statements/_statementSelected.asp?statement=31
http://seattletimes.nwsource.com/html/health/2003081435_ultrasound25.html

DMS program video

2009-10-26T19:28:00.001-04:00

FYI: Diagnositic Ultrasound principles and Instruments

2009-10-26T18:52:00.010-04:00

Diagnostic Ultrasound Principles and Instruments: Fundamentals and Advances

Presented by Frederick Kremkau, PhD
Date: December 5-6, 2009
Where: Montgomery College, Takoma Park campus, Maryland

Learner Objectives

Explain how the pulse-echo principle applies to sonography.
Describe the anatomic image formats used in sonography.
Explain how an ultrasound transducer works.
Describe the functions of the parts of a sonographic instrument.
List imaging artifacts that can occur in sonography.
Explain the risk and safety issues in sonography.
Describe how the Doppler effect is applied in diagnostic ultrasound.
List the ways in which Doppler information is presented by Doppler instruments.
Explain how aliasing occurs with Doppler ultrasound and how it is corrected.

This course is for any speciality of sonographers and physicians and all levels of experience from beginning to advanced. WELCOME!

Using Blogs in DMS

2009-04-23T14:38:00.000-04:00

Welcome to the DMS Program. As you have now found out we use a lot of technology in the DMS program. I would like you to use this blog to share information about why you choose sonography as a career.