It’s easy to get carried away when doing your own bedside ultrasound but it’s important to know your limits. Pablo Blanco and Giovanni Volpicelli have published an excellent article in Critical Ultrasound Journal 26 Oct. on some of the most common mistakes and pitfalls when performing point of care ultrasound. You can find it here.
Bedside ultrasound beats fluoroscopy at detecting diaphragmatic paralysis
In a recent online published study out of the children’s hospital in Barcelona, chest ultrasound outperformed fluoroscopy in the detection of diaphragmatic paralysis (Pediatric Critical Care Medicine Oct 28). This will save patients radiation and can be performed at the bedside. You can read more at about it at Health Imaging.
A Field Guide to Bedside Ultrasound – out now
We’re so excited! After a long gestation, our first book is finally out. It’s geared to those starting out in bedside ultrasound and offers a basic grounding in US technique. Concise and pocket-sized, it contains chapters on basic scanning of the most common applications such as scrotum, leg veins, abdomen, OB, lung and cardiac. Packed with tips and tricks it also has a chapter on US guided procedures and what to look for when buying your own machine. It’s available direct from our publisher or from Amazon. E-book versions are also available from iTunes and the Amazon Kindle store. To check it out, click on the link.
FiGBUS is going to the RSNA
Yay! FiGBUS is hitting the road and heading off to Chicago at the end of this month for the Radiological Society of North America’s Annual Conference. All the major medical imaging vendors exhibit and launch all their latest hardware and equipment at the RSNA each year so we’re hoping to bring you some exciting new ultrasound equipment updates from the exhibition floor. Watch this space.
What do Gallstones look like?
Cholecystitis is one of the more common ailments seen in emergency departments, and one of the most frequent indications for an abdominal ultrasound. Gallstones will appear as echogenic, or bright white, round stones within the gallbladder, with shadows posterior. The gallbladder itself will appear anechoic, or black, tubular structure, adjacent to the right lobe of the liver and the main portal vein. When assessing for cholecystitis here are some other sonographic signs:
-Look for mobility. Do the stones roll when you move the patient? Look at the gallbladder supine, stone will be sitting towards the “neck” of the gallbladder, because that is dependent location. Now try tolling your patient LLD, or even sitting up. The stones should roll to the fundus! If not, are they stuck in the neck?
– Is the gallbladder wall thick? Measure the wall in transverse and it should be less than 3 mm
-Is there free fluid? Look for a pointy, “triangle” shaped anechoic area beside the GB.
– Is there a positive Murphy’s Sign? When you apply pressure to the gallbladder, does this correspond with the patient’s area of pain? Often the response is quite clear.
Images courtesy of Radiopedia.org:
Case courtesy of Dr Derek Smith, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/42795″>rID: 42795</a>
Case courtesy of Dr Andrew Dixon, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/9558″>rID: 9558</a>
Case courtesy of RMH Core Conditions, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/38022″>rID: 38022</a>
Case courtesy of Dr M Osama Yonso, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/16769″>rID: 16769</a>
The Gallbladder
It’s Thanksgiving weekend, and what a fitting time to talk about the gallbladder. With the rich meals associated with the holidays, it’s no surprise that the emergency department fills with patients who have biliary tract disorders such as gallstones and cholecystitis.
Here are some tips on how to find the gallbladder on ultrasound. Begin with the patient supine, placing probe sagittally and to the right of mid-line. The image should show liver and the gallbladder. Often a held inspiration can help move obscuring bowel gas. Now often patients do not have a nice supine window, so next view to try is intercostal. Place the probe at right lateral position, scanning between the ribs. Next look at the gallbladder when the patient is in a left lateral decubitus position. Often this is the best view to look at the GB because the liver creates an acoustic window and the bowel moves to the left. Again, place probe subcostally, right of mid-line, and sweep with your probe in the sagittal position.
Below is an ultrasound image of a normal gallbladder. Stay tuned for further posts about gallbladder pathology!
Case courtesy of Dr Henry Knipe, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/48019″>rID: 48019</a>
Sonography Week 2016!
This week is Sonography Week, celebrating ultrasound and the dedication of medical professionals who use it. Below is a link to an interesting video demonstrating the development of ultrasound in healthcare. Hopefully it will inspire you to continue to learn about all that ultrasound can do!
Video Courtesy of Society of Diagnostic Medical Sonography.
https://www.youtube.com/watch?v=sVa7PJm2okk
Assessment is Key!
It cannot be stressed enough that the real shining star of ultrasound is the real-time assessment of a structure; the actual sweeping back and forth through the organ of interest. It can be all too easy for new scanners to focus on finding the organ and taking a picture of it. Don’t forget to sweep through that structure! Here’s a good example: When scanning a kidney in the sagittal plane, plant your probe and angle it side to side. As you sweep through the kidney, assess medial to lateral until you have scanned completely in and out of the kidney. You never know, you might pick up an exophytic cyst on the periphery of the kidney!
Don’t be discouraged if you aren’t getting textbook images at the beginning of your ultrasound journey, it’s the assessment that counts.
Learn to do the easy stuff first
Learn basic ultrasound skills first. Start with the lung, the gallbladder or with free abdominal fluid. Practice on the easy stuff. The science is constantly evolving. New studies demonstrating the value of bedside ultrasound and demonstrating its clinical value get published every month. Don’t wait until a headline grabs your attention and makes you think “I must start doing this” before you start learning. With basic ultrasound skills already learnt, picking up new ones is a cinch.
Don’t become discouraged
Learning to perform ultrasound takes a long time and a lot of practice. It’s also something which is not yet routinely practiced on the wards or in clinic. This means getting access to perform scans and then feedback on your scanning is difficult. This also means most people either never start the learning journey or drop out of learning early on. But if you are willing to persist, if you can delay the gratification that comes with learning this skill, for as long as it takes, the skill is yours to own.
If you learn to do the difficult stuff which most people can’t do, then very soon, people will start asking you to do it regularly. This makes you one step closer to being indispensable. Being indispensable gives you choices, job offers, promotions and job security.
So persevere. Put in the time. In this world “discretionary effort is King”. Sometimes entire careers are built during lunchtimes and after hours.