There is no doubt that over the past 10 years the average size of our patients has increased noticeably. It is well recognized that body habitus plays a role in echo image quality, with both unusually small and large patients potentially being difficult to image. There is however considerable variability between individuals and it is near impossible to predict image quality just by “sizing” the patient up.
Today’s post focuses on the “fifth” acoustic window to the heart, the right sternal edge (RSE). The right sternal edge , or right sternal border, allows improved visualization of the mid to distal ascending aorta and potentially an improved angle of incidence for assessing aortic stenosis. Whilst some consider this a routine component to the scan, other sonographers are quite unsure of how to approach this.
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.
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.
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.
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.
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.
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.
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.