General

Working in the UK – one Aussie’s perspective

Each year many sonographers travel abroad for work. For some, this is an opportunity to further develop their skills, for others it is simply a means to travel and see the world. I regularly receive emails asking my advice for working overseas. For today’s post I have asked Tim Eller to provide some insight on his experience working as a sonographer in the UK. Tim was responsible for a lot of my echo training, many years ago, before heading to the UK. Tim has since returned to Australia providing locum echo services throughout Queensland. Continue Reading

General

6 tips to land that Echo job

After a long break away from the computer I have been nudged back into writing with a flurry of activity on the jobs board.

Echocardiography is a fantastic career choice. The field is constantly evolving, and there are endless job opportunities making it an exciting long term option. A career in echo can take us around the world, branch off to eduction/training, research, management or an applications/sales role for a vendor; Every week I’m meeting readers who have found new directions to take their echo career. I have been fortunate to have sampled many of the different aspects to our field, and have now added website founder to the resume… There are record numbers of trainee sonographers about to enter the workforce, so how do you stay ahead of the pack to land the dream job??
This is not an exhaustive list, but my 6 tips will get you a long way to get noticed when hiring. These are also the factors I consider when I am sorting through applications or conducting interviews. Continue Reading

Quality Assurance

5 minutes with… Jeremy Daalder – Director, ImageScience

We spend a lot of money ensuring we are using quality ultrasound machines, often with the latest transducer and beam forming technology. We recognise that to obtain quality data we need to spend years on our education, and practicing our craft to develop the fine-motor skill and cognitive abilities to obtain the highest quality information of the heart. But, too often we then use cheap, poorly set-up monitors to view the images. This can be a bit like looking through a dirty windscreen (how do expect to drive the sportscar, if you can’t see properly). Many sonographers are simply unaware of the difference a properly set-up display monitor can make to our work. Proper monitor settings play a crucial role in QA processes in the echo lab, yet most of us take this aspect of our imaging for granted. Continue Reading

General

Are thick LV walls the same as LV hypertrophy??

Measuring left ventricular size and wall thickness is a standard part of the routine echo examination. There are normative values for LV wall thickness, and the trainee sonographer is taught basic pattern-recognition in the early phases of training to identify patients with left ventricular hypertrophy.  It is often assumed that Thick walls = hypertrophy. However the influence of left ventricular volume to wall thickness is completely overlooked in that equation. Today’s post looks at the relationship (or interaction) between wall thickness, LV volume and LV hypertrophy. Continue Reading

Quality Assurance

5 minutes with… Ashley Barker – President and CEO, ProbeLogic.

I have received many emails following my post highlighting the clinical impact of transducer damage. The feedback suggests that I wasn’t alone imaging in the dark and taking my probe for granted. To help answer some of the great questions from readers, I decided to get some help from transducer-guru and CEO at Probelogic, Ashley Barker. I am always blown away by Ashley’s knowledge in this area, and appreciate him taking the time to chat with Echo.Guru today. Continue Reading

General

Measuring pericardial effusions

I have just received another great topic idea from a reader asking about the technique for measuring pericardial effusions. There is often confusion about how to correctly measure free fluid in the pericardial space or how to report it. So today is just a short post with some imaging tips for measuring effusions.

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Opinion

My thoughts on the revised ASE Chamber Quantification Guidelines…

The much anticipated revised guidelines for chamber quantification have been released and feature in the January publication of JASE. This is a massive undertaking and I want to start my review by acknowledging the efforts of the writing group – I can appreciate how difficult the task is! In today’s post I will aim to draw attention to some notable changes from the 2005 paper and share some of my opinions on these changes – it is not aimed to be a complete analysis of the document.
The 2005 paper is arguably the most significant echo paper published and the revised edition overall has improved significantly on this document. There has been a large growth in the amount of normal data available for the authors to base guidelines and the revised paper reflects the technological advances which have become routine clinical practice in many centres (i.e. real-time 3D and Strain). As an educator, the goal of a guideline paper is to reduce variability in how to measure and interpret findings. It represents the “go-to” document that summarises the various different techniques and papers available. This guideline revision has improved significantly on the previous guidelines, however I feel that several new challenges have arisen. Continue Reading

Quality Assurance

How much do you trust your transducer??

Do you blindly trust that your transducer is working? Do you know if there is any damage to the internal workings of the transducer? Would you bet your patient’s health on it?? Most of us take for granted that our equipment is functioning normally and that what we are imaging is the “truth”. A regular comment from sonographers is that the ultrasound system they are using is too old and takes poor images. If the machine is regularly serviced I would almost certainly bet the fault is with the transducer, not the machine.
It can be difficult to identify significant probe damage in a phased array transducer. We often don’t appreciate that a probe is deteriorating as there is a lot of variation in image quality between patients – we tend to attribute poor images to the patient rather than considering our equipment as a contributing factor. Today’s post highlights the need to regularly check the integrity of our transducers and proposes a basic protocol for routine transducer testing.

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General

Which axis is best to measure from?

Happy New Year!! Let’s kick 2015 off with a reader question.
Many measurements in Echo can be made from multiple locations (PLAX vs PSAX; A5C vs ALAX). Experienced sonographers will have a “favorite” way of imaging which is passed down to the next generation of trainee sonographers as the “correct” way, although we often do a poor job of verbalizing “Why” we measure one way over the other. Theories are thrown around, some hilarious, some reasonably valid…but at the end of the day all the techniques are probably just as good as each other; we just need to be aware of the pitfalls. The published guidelines suggest that for some measurements we can use either axis, however as an Echo.Guru reader pointed out recently, the measurements may be different between the two views… so which axis is best to measure from??

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General

ALAX…the tricky view??

The apical long axis (ALAX) can be a difficult view to master for many sonographers. A quality, on-axis image is obtained when the image transects the true apex and also needs to pass through the center of the mitral valve (commonly the middle scallops: P2 and A2). The aortic valve leaflets should also be seen to be opening well and the ascending aorta is opened out. It can sometimes be challenging to achieve all these aspects in the one image. Here are some tips  for imaging this view on-axis every time! Continue Reading