Sonographers Blog

Trans-Cranial Ultrasound Clot Buster

2011-12-29T11:28:00.000-08:00

I have been speaking about this technology for years in the classroom. Now it seems we have a commercial product with a CE endorsement that is evidence driven to be beneficial in the treatment of ischemic stroke (caused by a clot). This technology uses ultrasound to vibrate a blood clot in the brain allowing better perfusion of clot busting drugs to break it up. It has been used in research for years, but was very user intensive requiring the person aiming the probe to have extensive training in cranial anatomy. This news is wonderful as ischemic strokes are a significant cause of death and disability around the world. This technology cannot be used in hemorrhagic strokes though. Happy New Year All!

REDMOND, Wash., Dec. 19, 2011 /PRNewswire/ -- Cerevast Therapeutics Inc., a privately held medical technology company, announced today that it has received CE mark clearance of its SonoLysis Headframe System, the Clotbust ER™providing approval to commercialize the product in Europe.

(Logo: http://photos.prnewswire.com/prnh/20111219/SF24705LOGO)

The Clotbust ER™ is a first-in-class ultrasound device for the treatment of ischemic stroke, representing a novel product in an extremely high area of unmet medical need. Designed for rapid deployment in the emergency room setting, the device has been engineered to non-invasively deliver therapeutic ultrasound energy to the region of the occluded vessel in the brain as a treatment for ischemic stroke when used in combination with standard intravenous thrombolytic therapy (tissue plasminogen activator - tPA/Alteplase).

http://www.prnewswire.com/news-releases/cerevast-therapeutics-receives-ce-mark-for-clotbust-er-ultrasound-stroke-treatment-device-135850183.html

Ultrasound and Evolution: a Personal retrospective ( Part 2)

2011-11-13T10:50:00.000-08:00

I am sorry for being tardy in my next installment of this series. Like many bad writers, we tend to think more than write. I appreciate all who have commented on the blog. I certainly like your comments. Getting old is no fun, but I like to make it informative if nothing else. To the left you see an invention that was something I looked at briefly when I was young. I recall a machine invented in Australia. I think the machine is called the Maytag Sonogram machine.

News first: FDA took back the warnings on the ultrasound contrast in the USA. PLEASE contact the senator or congressman to urge the FDA to allow ultrasound contrast to be used in many other procedures. Please link ICUS.org

I linked a great author to this blog. Pier Anthony Jacob (Pen name). I hope he will tell me hello. I arrived at the central airport in Denver in 1978, and fumbled around for my luggage, and retrieved them sans the Janet Nepalitono scrutiny. Folk's, this is before the issues we face now. Lets get back to the story. My hospital bought a Unirad Machine. Yep (Johnson and Johnson). Many of you know what we are talking about. It was like Keith Emerson's Monster Moog. OMG! and here I am tryying to learn how to use it.
The speaker has no idea what an ultrasound is, yet his hair is perfect. We all ask where a good lunch is. He has no idea.
I will never reveal the name of the speaker. He might be a presidential adviser. We all got on the Branniff airplanes and go home. It happened folk's. Stapleton International Airport, Hilton Hotel. Let me know if you were there.. To Be continued. Bless you all.

2011-10-11T13:29:00.000-07:00

The International Contrast Ultrasound Society recently filed a petition with the FDA to remove the black box warning from ultrasound contrast agents used in the USA. These IV medications have been proven time after time to be safe and effective, yet the FDA is persistent with its invalid warnings. I am a member of the ICUS, and I support the move, and hope the FDA will consider this petition, as well as consider allowing use of IV ultrasound contrast agents in other areas of diagnostic ultrasound like many other nations.

CHICAGO, Oct 03, 2011 (BUSINESS WIRE) -- Cross-specialty international medical experts filed a Citizen Petition with the FDA today, asking the agency to remove boxed warnings from ultrasound contrast agents, stating that the warnings deter use of a safe, inexpensive and radiation-free diagnostic imaging tool with potential life-saving benefits for patients.

http://www.marketwatch.com/story/citizen-petition-seeks-removal-of-boxed-warnings-on-ultrasound-contrast-agents-new-safety-data-cited-2011-10-03

Ultrasound and Evolution: A personal retrospective (Part 1)

2011-08-02T10:55:00.000-07:00

I started life as a Medical Radiographer. I graduated in the late 70's with a degree in radiologic health science, and proceeded to go to work in the hospital where I trained, a 320 bed hospital in north Texas. Back in the 70's it was hard on people who were sick. Going to X-Ray was a trip to the torture chamber some patients would recall. Pain in the tummy? Well, let's see: We can give you an oral cholecystogram, and IVP, a barium enema, and an upper-GI to start with. Headache? We can really make your day with a pneumoencephalogram (a procedure whereby we insert a needle into the neural tube in your back, then inject room air to see how it behaves in the ventricles of the brain). These patients would scream in pain due to the pressure of the air in their head. If these examinations failed to find the problem the surgeon would wander into the room and confess that it was time to perform a diagnostic laparotomy (belly cases) or another surgical procedure. For those of you reading this, be patient. What I am relating to you are my personal experiences starting from over 30 years ago. Call this a personal retrospective.

When I went to work F/T at the hospital, I was trained to perform special procedures. Angiography before digital imaging involved something called "film". We were trained to load and process film in a dark room. The angiogram was performed by exposing several sheets of film loaded into a film changer to x-rays. In the cases of a cerebral angiogram, films were bi-plane. In other words, the films were rapidly taken from two perspectives: AP and medio-lateral. I usually scrubbed in and assisted the radiologist with the surgical portion of guiding a catheter into an artery in the brain, then injecting meglumine (Conray or Reno-76). The surgical procedure has not changed much over the years, with the exception that I no longer give valium and demerol to the patient to control pain and anxiety. This is now handled by an RN or anesthesiologist Yes, you read correctly. Part of my job was to administer medications to the patient during the procedure (though I was poorly trained to do this part). Scope of practice for many health care professionals were poorly defined at this time.

The late 70's were a period of Renaissance in medical imaging. I am fortunate to have been fresh out of school when the CAT scanner and B-scanner ultrasound machines were being purchased by the progressive hospitals of the day. Radiologists who were never trained in cross sectional anatomy were pulling their hair out trying to correlate what was shown on the CT and what anatomy they were seeing. Ultrasound was even worse on the Radiologist. One guy I worked for compared ultrasound to looking at post modern art made by elephants with buckets of black paint and brushes in their trunks.

It all changed for me one day when the administrator of the hospital asked me to accompany him to a storage room in the bowels of the hospital. We opened a huge wooden crate and inside there was a contraption that could have been the Doppelganger of Keith Emerson's Monster Moog music synthesizer. As I was a keyboard musician I excitedly asked the administrator if this was a musical instrument. He replied that it was a sound wave machine for medical purposes and the chief of staff had asked him to purchase it for the X-ray department. He continued by asking me if I was interested in attending a three day seminar on the use of the instrument (Unirad B scanner Johnson and Johnson Corporation). He offered me my own department if I succeeded. Since I was young and energetic I agreed (Knowing full well that an 18 year old new X-Ray graduate with his own department in a large hospital with a nursing program may very well become a chick magnet).

I was off to Denver on a mission!

To Be Continued...

Plants Attract Bats With Physics

2011-08-02T09:14:00.000-07:00

Examples of physics abound in the natural world. Many animals and plants utilize the natural laws of our universe to live, reproduce, and obtain food. It has been known for many years that bats use high frequency sound waves to echo-locate insects on nightly forays in search of food. What has recently been discovered is a plant that actively encourages bats to drink nectar from it's fruit, and spread pollen in the process by forming echo-genic leaves designed to allow bats an easier time in finding the fruiting portions of the plant. Isn't life marvelous?

Most plants are pollinated through bees, but one plant, Marcgravia evenia, which grows in the Cuban rainforest, has it a little harder: it has to attract on-the-go bats in the dark of night.

Instead of using their eyes, the flying mammals orient themselves with echolocation: they send out ultrasound waves and listen closely to which sounds echo back.

According to a study published Friday in the journal Science, a team of British, German and Canadian researchers have shown that this newly-discovered plant that has evolved to reflect back especially audible ultrasound waves. Marcgravia evenia achieves this through concave, spherically shaped leaves.

http://www.dw-world.de/dw/article/0,,15276492,00.html

Ultrasound Replaces CT As First Choice

2011-06-17T09:12:00.000-07:00

As many of you know I am very much a supporter of ultrasound being the first medical imaging modality utilized when a patient needs medical imaging to establish a diagnosis. I am on the record as saying medical ultrasound is a great way to start out when a patient presents with symptoms of appendicitis. As an example, ultrasound is not used to R/O the disease, it is used to "rule in" appendicitis. The reason is two fold: 1) a CT scan is expensive 2) A CT scan involves ionizing radiation. Many people are realizing these issues. Here is part of an article I saw online addressing this topic.

OREM, UT, June 02, 2011 /24-7PressRelease/ -- Just as insurance carriers are scrutinizing the higher cost of a CT scan versus that of an ultrasound for diagnostic screenings, patients are becoming aware of and concerned about the amount of radiation delivered by a CT scan. This is leading to an increased number of ultrasounds being performed in several medical situations.

http://www.einnews.com/247pr/216724

Hospital Medicine Probes The Use of Ultrasound

2011-06-14T11:50:00.000-07:00

A doctor who treats only patients admitted to a hospital is often referred to as a "hospitalist". I have met a few of these versatile doctors in my job as an ultrasound instructor. These doctors are charged with dealing with the problems that flare up like wild fires when other physicians are home in bed. They are trained to deal with many issues, and they are trained to know their limits. Many of these issues occur in the ICU or CCU and are cardiac, or surgically related. It is natural for them to be creative with patient care, because they are often working alone without the help of other physicians. Naturally, hospitalists are discovering the wonderful tool called portable ultrasound. It makes perfect sense when trying to insert a line in the internal jugular to use ultrasound as a guide. What about post surgical bleeding? Piece of cake. Cardiac issues? Pull out the cardiac probe to scan for a pericardial effusion. My job is to train the wonderful doctors and give the tools and expertise at making a rapid and accurate diagnosis with portable ultrasound.

“The ultrasound will be the stethoscope of the 21st century,” says Mark Ault, director of the Division of General Internal Medicine and assistant chairman for clinical affairs of the Department of Medicine at Cedars-Sinai Medical Center in Los Angeles. “And the goal will be to have an ultrasound in the hands of every internist.”

http://www.the-hospitalist.org/details/article/1072699/The_Future_of_Better_Patient_Care.htmlhttp://www.the-hospitalist.org/details/article/1072699/The_Future_of_Better_Patient_Care.html

NASA And Ultrasound

2011-06-07T09:11:00.000-07:00

The machine you see to the left is a Philips 5000 modular ultrasound machine which is installed in the ISS. I have good friends that work at Johnson Space Center in Houston and many are physicians. One of the benefits of the ISS is the medical research that is performed there by the astronauts. One of the most useful technologies they use is the ultrasound machine. They study everything from optic nerve diameters to diastolic function of the heart in the weightless environment. As the medical director of the ISS once said to me: "One of the biggest challenges to the space program is keeping people alive and well in the hostile environment of outer space". The machine pictured to the left recently died, and a smaller replacement ultrasound machine will be sent up to replace it.

A recent article on Space on MSNBC.com shows astronaut Leroy Chiao performing an eye examination onboard the International Space Station. The exam was performed on Salizhan Sharipov, a cosmonaut who took advantage of NASA’s ultrasound-based “all purpose diagnostic machine”. This ultrasound machine is unique, in that it is directly linked from the Space Station to doctors on Earth. Why use ultrasound machines in space? Like most of the other space-bound experiments, it has a practical application.

http://portableultrasoundmachines.net/nasa-space-inventions-benefit-all-our-lives-on-earth-space-on-msnbc-com/396/

Diastolic CHF

2011-06-02T08:54:00.000-07:00

Cardiologists have known for years that a patient may have a systolic ejection of over 55 percent and normal wall motion but still suffer from congestive heart failure. Yes you heard me right. Diastolic heart failure is a real entity, and it is not taken seriously by all medical professionals. Recently, many papers have been published stressing the importance of treating diastolic dysfunction with medications, diet and exercise. The long term effects of diastolic heart disease are devastating frequently leading up to chronic illnesses that are a challenge to treat from both a medical and an economical standpoint.

http://dmtrk.net/BTE-FS61-3BX0GY-656LN-1/c.aspx

If that link does not work try this one:
http://www.touchcardiology.com/articles/echocardiographic-assessment-diastolic-heart-failure

Ultrasound and CT Re-Visited

2011-05-02T06:58:00.000-07:00

Ultrasound is a logical choice to use when evaluating a patient for suspected appendicitis because it is economical, and does not utilize radiation. Ultrasound is used to rule in appendicitis, not rule it out. This concept is very important especially when dealing with children. The thinking is that we would like to utilize everything possible in the evaluation that does not use radiation. America has traditionally been too quick to send patients to the CT scanner. It is a simple matter for the trained Sonographer or Physician to "take a look" with ultrasound. We need to revisit these concepts.

April 18, 2011 -- NEW YORK CITY - Partially substituting ultrasound for CT in evaluating appendicitis could save the U.S. healthcare system more than $1 billion, according to research presented Saturday at the American Institute of Ultrasound in Medicine (AIUM) annual meeting.

While ultrasound has high positive predictive value for appendicitis and provides low cost and no radiation exposure, the modality appears underutilized in this application, according to Dr. Levon Nazarian. He presented the research findings on behalf of lead author Laurence Parker, PhD.

Here is the link to the article through Auntminnie:
http://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=94982

Ultrasound or CT for Testicular Imaging

2011-04-21T07:11:00.000-07:00

I came across an interesting article regarding CT being used to watch for the spread of testicular cancer in patients electing not to have an orchiectomy for an early lesion. These patients were either older, or men who feared the side effects of orchiectomy such as impotence. It seems since the early 1980s CT has been the method of choice for checking to see if the retroperitoneal lymph nodes become involved. The article further goes on to discuss the secondary cancers associated with this form of surveillance. I would think ultrasound would be a less hazardous approach in this regard. But I am only a Sonographer.

"In the 1990s, nearly half of patients diagnosed with early-stage disease were treated with orchiectomy (testicle removal) alone. For those patients, the US National Comprehensive Cancer Network Guidelines recommend a total of 15 CT scans in the first five years after surgery (every two to three months for the first year, then tapering off each consecutive year) to check for new signs of disease. After four years, CT scans are recommended just once annually.

Excessive CT scanning has been the topic of considerable debate in recent years; as the technology has become better at detecting disease, it has been used with far more frequency, exposing more people to ionizing radiation, which can cause cancer at high doses. “What has happened is that because CT images are so diagnostically useful, physicians request them for their patients in great numbers, so the concerns are really based upon the fact that 80 million CT scans are performed every year in the US,” said Dr. Boone. “That is a huge number.”

Here is the link:

http://www.medimaging.net/?option=com_article&Itemid=294734528&cat=Radiography&ui=1960153452&vrf=5eb1172e9330e9b43c04466683fbb540&end=%2520

High Intensity Focused Ultrasound Breakthrough

2011-03-16T08:04:00.000-07:00

The following link describes a new procedure where HIFU is used to treat essential tremor. I will watch developments in this area with interest since it may herald a new way to treat other brain diseases.

A new chapter in medical history opened days ago when noninvasive MR-guided focused ultrasound was used to successfully treat a patient with essential tremor (ET), a progressive neurological disorder that affects millions of people worldwide and causes involuntary shaking of the hands, head, face, eyelids, voice or other muscles.

http://www.fusfoundation.org/Newsletter/fusf-newsletter-volume-29

New Treatment For Pulmonary Embolism

2011-01-26T06:48:00.000-08:00

A new treatment for PE's is causing a stir in the medical community. It seems a catheter system that injects medication while stimulating a clot with ultrasound waves has proven very effective in treating this potentially life threatening condition.

In traditional therapy, thrombolytic drugs are delivered to the blockage, but the method can take many hours or even days. In the ultrasound method, the device (EkoSonic System, Ekos) is advanced through the femoral artery to the clot, where it emits sound waves that loosen the clot, allowing the thrombolytic drugs to dissolve it faster. The system has received a CE mark and FDA approval for treatment of peripheral arterial disease, and recently received a CE mark for use in PEs.

http://www.cardiovascularbusiness.com/index.php?option=com_articles&view=article&id=25867:iset-feature-ultrasound-assisted-thrombolysis-for-pe-shows-promise

Best Musicians IMHO

2011-01-01T20:48:00.000-08:00

I am a Sonographer. I am also a musician. I have an opinion about sound. I love the music that makes me weep. Music can cure many ills. Best Musicians in my life time: Well, heck you see the picture. Best bassist: Geddy Lee. Best guitarist: Steve Howe Best vocalist: Jon Anderson. Best percussionist: that bald guy from Genisus. Best dancer? Who cares. Best Musician? Keith Emerson. Runner up? Tony Banks. Happy New Year.

Musculoskeletal Ultrasound Growth Noteworthy

2010-12-29T07:05:00.000-08:00

The popularity of musculoskeletal ultrasound (MSK-US) has taken off in recent years with the addition of portable ultrasound technology and greater imaging resolution. This area of growth has not been fueled by radiologists, instead many physicians in sports medicine, general practice and rheumatology are driving this phenomenon. I work in the health care educational field, and I have noticed out courses in MSK are very popular. Our next general course in MSK-US is Feb 26-27 here in Houston. Please visit www.aheconline.com for more information. I think MSK-US is a wonderful tool for examining all sorts of aches and pains, and I predict it will continue to grow as more health care providers discover the benefits. Here is part of an article I found at Auntminnie that explains this topic further. Cheers!

December 2, 2010 -- CHICAGO - Musculoskeletal ultrasound usage nearly quadrupled between 2000 and 2008, driven primarily by increased utilization by nonradiologists, according to a study presented Thursday at the 2010 RSNA meeting in Chicago.

http://www.auntminnie.com/index.aspx?sec=sup&sub=ult&pag=dis&itemId=93452

Stress Echocardiography New and Improved?

2010-12-16T09:50:00.000-08:00

Some news came out today regarding one of the FDA approved ultrasound contrast agents regarding the use of contrast when performing stress echocardiography.

No. BILLERICA, Mass. (December 13, 2010) – Lantheus Medical Imaging, Inc., a worldwide leader in diagnostic medical imaging, today announced that the U.S. Food and Drug Administration (FDA) has accepted for review the company’s supplemental New Drug Application (sNDA) for DEFINITY® (Perflutren Lipid Microsphere) Injectable Suspension for use in stress echocardiography. DEFINITY® is currently indicated for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border¹. With this acceptance, the FDA will now review the sNDA to determine whether or not to broaden the FDA-approved indication for DEFINITY® to include its use with exercise and pharmacologic stress testing.

Several labs have been using intravenous ultrasound contrast for years when performing stress echos because the border definition is better for most studies when contrast is applied. One of the downsides to a stress echo is the loss of wall definition at peak exercise even in patients who have fairly good windows. Contrast adds an extra level of insurance that the walls will be seen better in most echos. It is news to me that the FDA has not approved contrast for use in stress echo, but has approved it for many years in resting echocardiography. Perhaps the up side here is that labs can now be re-reimbursed for using contrast in this capacity. I had erroneously thought that the FDA had already approved intravenous ultrasound contrast for both resting and stress echos. Live and learn.
http://www.radiopharm.com/News-Press-2010-1213.html

Man is Told He is Pregnant in the UK

2010-12-15T09:21:00.000-08:00

A man in the UK has been sent a letter by the state run health service informing him that he is pregnant. Last time I heard of this happened it involved a California Govinator in a Hollywood movie. I guess this goes in the same category as family pets being sent credit card applications. I wonder who will host the baby shower.

Hilton Plettell should expect the pitter-patter of tiny feet in seven months’ time, according to the correspondence sent to him from the obstetric department of a hospital in Norwich.

The 50-year-old, from Kings Heath, said he was “flabbergasted” when he received the appointment letter inviting him to a scan – and warning him he could be expecting twins!

Opening “Dear Mr Plettell”, the note also advised him: “Please also attend with a full bladder, which is important for your planned ultrasound. An ultrasound scan is used to check the pregnancy, to determine how far pregnant you are, and sometimes it can show twins.”

Hilton, who never got round to having children and works as a merchandising manager, said: “It came as a bit of a shock, I’ve shown the letter to quite a few friends and they can’t believe it.

“I knew the letter was genuine. The date of birth, the National Insurance number and everything on there is correct. I’m just surprised they can send something like that.”

HE is on HIS Way

2010-12-06T11:23:00.000-08:00

An ecumenical Christian nonprofit group in England has created a unique Advent advertising campaign. Starting Monday, and running through December 20, billboards and posters will show a mock-up of an ultrasound of baby Jesus, complete with halo. The words are simple: “He’s on His way . . . Christmas starts with Christ.”

Merry Christmas All

http://online.worldmag.com/2010/12/03/ultrasound-of-baby-jesus/

K-Mart to Screen for Triple A's

2010-10-07T09:24:00.000-07:00

Recently, I have been very busy with work, and have not had much time to post. I came across something on Sonoworld ( www.sonoworld.com ) that is worthy of attention. It seems many K-marts around the country have begun screening patients in their pharmacy's for abdominal aortic aneurysms (AAA). They have teamed up with a few good organizations including the SVU to provide this free service. No where in the information is there a reference to the qualifications of the health care providers being used to screen these patients. As a Registered Vascular Sonographer, I think it is important to point out to patients that Sonographers are medical professionals, and we specialize in ultrasound. Many states limit the use of ultrasound in the medical field to those who have demonstrated a proficiency by sitting for written boards, and passing the medical tests needed to gain a credential in medical ultrasound (RVT, or RVS) through either the ARDMS, or CCI. I am wondering if K-Mart is using registered vascular sonographers? Any input is welcome.

Kmart Pharmacy Joins Fight Against Abdominal Aortic Aneurysms (AAA)

Retail Partner for Find the AAAnswers Campaign Will Support Free Education, Risk Assessment and Screening for Potentially Fatal Vascular Disease Affecting More Than 1 Million Americans

http://www.marketwire.com/press-release/Kmart-Pharmacy-Joins-Fight-Against-Abdominal-Aortic-Aneurysms-AAA-1316778.htm

New Ways Of Boosting Healthful Antioxidant Levels In Potatoes

2010-09-01T07:58:00.000-07:00

I am always impressed with what scientists discover while they are messing around in the lab. You probably know how saccharine was discovered: a scientist accidentally tasted a substance he was working on and found it to be very sweet. I must wonder aloud what prompted these geniuses to insonate potatoes in the first place. Here is to the serendipitous discovery of the month!

Here's a scientific discovery fit to give Mr. Potato Head static cling and flyaway hair (if that vintage plastic toy had hair). Scientists have reported discovery of two simple, inexpensive ways of boosting the amounts of healthful antioxidant substances in potatoes. One involves giving spuds an electric shock. The other involves zapping them with ultrasound, high frequency sound waves

http://www.medicalnewstoday.com/articles/198579.php

Usefulness of an accelerated transoesophageal stress echocardiography in severe obesity...

2010-08-26T10:14:00.000-07:00

Evaluating patients who are awaiting gastric bypass surgery for underlying ischemic heart disease has been historically problematic. The main issue of course is that many of these patients will have non-diagnostic or sub-optimal trans thoracic stress echocardiograms. A recent paper which I will post proposes that this subset of patients instead undergo Dubutamine trans-esophageal stress echocardiograms.

"TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event."

http://www.cardiovascularultrasound.com/content/8/1/30

Yet Another Study Proves Safety Of Ultrasound Contrast

2010-08-10T09:42:00.000-07:00

I was scanning the news at Aunt Minnie this morning and noticed another study has been completed concerning the safety of ultrasound contrast. An editorial linked with the article asked a great question: "Is the FDA listening?" Folks it has been proven by 3 years of research that ultrasound contrast agents used here in the USA for echocardiography are safe and effective, yet the FDA refuses to remove the black box warning on Optison and Definity. And further more, the FDA refuses to allow Doctors to use ultrasound contrast in other imaging applications such as categorization of liver masses which has proven very useful when screening hepatitis sufferers for hepatocellular carcinoma. It is high time the FDA stops acting like an ostrich and remove it's head from the hole in the ground.

NEW YORK (Reuters Health), Aug 10 - Contrary to earlier concerns, using contrast agents in echocardiography does not lead to more myocardial infarctions (MIs) or deaths, a new meta-analysis has shown.

"This analysis should put to rest the concerns about the safety of echo contrast agents. The usefulness of these agents has been shown in many studies and they should be used in these clinical situations," senior author Dr. Mouaz H. Al-Mallah told Reuters Health by e-mail.
In October 2007, based on four reported deaths after administration of an ultrasound contrast agent, the U.S. Food and Drug Administration issued a black box warning for all such agents, the researchers note in their paper. Contrast agents were specifically contraindicated in patients with acute cardiopulmonary syndromes, severe pulmonary hypertension, and QT prolongation."

http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=91603&wf=3859

Cheers To The Echo Class Of July, 2010

2010-08-03T09:25:00.000-07:00

Advanced Health Education Center salutes the July 2010 Echocardiography class who graduated Monday August 2. Hats off Ladies and Gentlemen for a job well done. I will remember this group of individuals for their persistence in learning the intricacies of an echocardiogram along with the Doppler examination which has gotten quite complex over the years. Kudos to the lone Cardiologist who took the course as a "refresher" and thanks to his family, provided a wonderful lunch complete with an operatic performance by his gifted 18 year old son at his residence. Thank you all very much for making my job enjoyable. TJW

On Another Note: Pancreatic Cancer Fueled By Sugar

2010-08-03T09:14:00.000-07:00

WOW, Western diets cultivate pancreatic cancer? I would have thought the way we eat in the west is so darn healthy. Isn't Mickey Dee's and a soft drink eating responsibly? So many people here in the west cannot be wrong!

Although it's widely known that cancers use glucose, a simple sugar, to fuel their growth, this is the first time a link has been shown between fructose and cancer proliferation, said Dr. Anthony Heaney, an associate professor of medicine and neurosurgery, a Jonsson Cancer Center researcher and senior author of the study.

"The bottom line is the modern diet contains a lot of refined sugar including fructose and it's a hidden danger implicated in a lot of modern diseases, such as obesity, diabetes and fatty liver," said Heaney, who also serves as director of the Pituitary Tumor and Neuroendocrine Program at UCLA. "In this study, we show that cancers can use fructose just as readily as glucose to fuel their growth."

The study appeared in the Aug. 1 issue of the peer-reviewed journal Cancer Research.

http://www.physorg.com/news200046187.html

Endoscopic Ultrasound And Pancreatic Ultrasound

2010-08-02T12:55:00.000-07:00

Pancreatic cancer is difficult to diagnose in the early stages because there may be no symptoms, and this makes it difficult to treat effectively. Endoscopic pancreatic ultrasound has recently been used to diagnose , biopsy and aid in treatment of small pancreatic lesions.

A new study has found that endoscopic ultrasound (EUS) is associated with improved outcomes in patients with localized pancreatic cancer, possibly due to the detection of earlier cancers and improved stage-appropriate management, including more selective performance of curative intent surgery. This is the first study to analyze a large population-based cancer registry and demonstrate that EUS evaluation is associated with improved pancreatic cancer survival. The study appears in the July issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

http://www.medicalnewstoday.com/articles/194287.php

Another promising technology is called high intensity focused ultrasound (HIFU) and is being researched as a way of literally destroying the tumor using ultrasound energy.

Paramedics Can Perform Limited Sonograms

2010-06-25T07:45:00.000-07:00

Paramedics have been taught to perform limited sonograms while en-route or at the scene of emergencies. Now why hasn't this been thought of before? Well, it has. It has not taken off in America though. I am not sure why, because it makes perfect sense. The company I work for is marketing courses designed to train EMS and paramedics to do limited focused ultrasounds. The goal would be to identify specific life threatening emergencies on the scene or en-route and to communicate the nature of these emergencies so as to prepare hospital professionals to be ready for issues such as free intraperitoneal fluid, pericardial effusions, or abdominal aortic aneurysms. Why not go further and train the paramedics to do other simple procedures? Maybe train them to scan a patient in labor to identify breach births or oligohydramnios? That could prove to be very useful.

Paramedics can obtain and interpret ultrasonograms in the back of moving ambulances, new research confirms.

Prehospital ultrasonography has been successfully implemented and is being consistently used in Germany, France, Italy, and some Scandinavian countries, but in the U.S. it's "still in the early development stage," according to lead author Dr. William Heegaard of Hennepin County Medical Center in Minneapolis and colleagues.

http://emsresponder.com/article/article.jsp?id=13766&siteSection=1

On The Plane Again

2010-06-10T12:23:00.000-07:00

I Am leaving for Kuwait on Saturday to deliver a two day lecture on critical care ultrasound. My audience will be many of the talented ED physicians who run the country's trauma centers. The trip will be long as I will make stops in Brussels, and Frankfurt. Total length of the trip will be 7,763 miles one way. The trip will take me 23 hours total with 4 hours layover in Frankfurt. Honestly, I am dreading be seated for this long, and I will take steps to avoid DVT by wearing pressure stockings and getting up often to walk around the back of the plane. I look forward to my first trip to Kuwait. I will post some pictures on my AHEC's facebook page when I return. If I have internet access there I will try to post. ~Gizz

Ultrasonographic Brain Stimulation May Enhance Brain Function

2010-06-10T12:11:00.000-07:00

Scientists have known for a while that ultrasound can stimulate neurons in the brain. There has been no use until now for this side effect of acoustic energy. Recently, new equipment breakthroughs have allowed scientists to target areas in the brain and observe the results. This may have the potential to treat a variety of brain ailments.

ScienceDaily (June 9, 2010) — The ability to diagnose and treat brain dysfunction without surgery, may rely on a new method of noninvasive brain stimulation using pulsed ultrasound developed by a team of scientists led by William "Jamie" Tyler, a neuroscientist at Arizona State University. Further reading:

http://www.sciencedaily.com/releases/2010/06/100609122832.htm

Echocardiograms Not Interpreted

2010-05-28T10:13:00.000-07:00

With all that is going on in health care, now we have something new to worry about.

"Nearly 4,000 tests for heart disease performed over the last three years at Harlem Hospital Center — more than half of all such tests performed — were never read by doctors charged with making a diagnosis, hospital officials acknowledged Tuesday."

People assume medical testing is scrutinized rigorously by Doctors interested in only the highest quality medical testing and treatment. The public assumes that when they talk to their Doctor about a medical test or procedure, the discussion is based upon rigid quality assurance. For example; if the Doctor calls a patient to tell them their mammogram is normal, most people assume they have nothing more to worry about. This article regarding echocardiograms that were never reviewed by a physician is a clarion reminder that patients must always be involved in their medical care. As an echocardiographer, it pains me to read it knowing that serious diseases or conditions could have gone unreported. We echocardiographers are charged with obtaining diagnostic information and images to be reviewed by a qualified physician so a medical diagnosis can be made. An echocardiographer does not generate a final report, or a medical diagnosis from the images obtained from an echocardiogram. Many institutions require the echocardiographer to generate a preliminary report, but that is not the same as a physician reviewed final report. Most of my colleagues will cringe when they read this piece.

"While the process the doctors followed may have alerted cardiologists to those echocardiograms that were most likely to be abnormal, the failure to read the echocardiograms in a timely manner is inexcusable and may have placed patients at risk,” Alan D. Aviles, hospitals corporation president, said in the statement."

Read the full article here.
http://www.nytimes.com/2010/05/26/nyregion/26hospital.html

New Trials Attempt To Bring Ultrasound Contrast to America (Again)

2010-05-25T07:45:00.000-07:00

As many of you know, I am a big fan of contrast enhanced ultrasound (CEUS). The United States FDA has limited its use to echocardiography. CEUS has been used safely for many other procedures in other countries for several years. There are several issues at play as to why the USA is lagging behind other countries in this area of diagnostic ultrasound. I won't go into them all except to say that a few years ago CEUS got a bad rap here for being falsely implicated in some patient deaths. A new endeavor is currently in the works to establish some trials in America with the goal of identifying safe, and effective means of providing useful information in other goal-directed studies including identification of some liver and kidney masses to name but a couple. Europe has been using CEUS for some time now to differentiate liver masses in terms of cancerous versus benign hyper-plastic lesions, and with great results. I think it is time we set politics aside, and do some good research that may allow us Americans access to affordable, and safe alternatives to other expensive diagnostic solutions such as CT and MRI. Here is a link to an article I saw on Aunt Minnie this morning.

ATLANTIC CITY, NJ - The lack of approval of radiology ultrasound contrast in the U.S. has long stuck in the craw of the technology's advocates. But clinical trials are now moving forward with hopes of rectifying the situation, according to a presentation at the annual Leading Edge in Diagnostic Ultrasound conference. http://www.auntminnie.com/index.asp?Sec=sup&Sub=ult&Pag=dis&ItemId=90583&wf=3735

Ultrasound As A Long-Term, Reversible Contraceptive

2010-05-20T09:15:00.000-07:00

A recent article announced the awarding of several grants by the Gates foundation for "Grand Challenge Exploration". One of the grants research centers on male contraception using ultrasound thermal destruction of sperm.

CHAPEL HILL — The University of North Carolina at Chapel Hill has received a $100,000 Grand Challenges Explorations grant from the Bill & Melinda Gates Foundation. The grant will support an innovative global health research project conducted by James Tsuruta, PhD, and Paul Dayton, PhD, titled “Ultrasound as a long-term, reversible contraceptive.”

“Our long-term goal is to use ultrasound from therapeutic instruments that are commonly found in sports medicine or physical therapy clinics as an inexpensive, long-term, reversible male contraceptive suitable for use in developing to first world countries,” said Tsuruta." What about the long term risk of cancer or other diseases? And what about the effects on the remaining germ cells? Is the DNA affected? Are they talking about therapeutic ultrasound machines used to treat muscle pain? Is the procedure painful? I will keep my eye on this hot topic.

http://www.med.unc.edu/www/news/unc-researchers-receive-100-000-grand-challenges-exploration-grant-to-develop-male-contraceptive

Canada To Charge For Gender Identification

2010-05-19T08:20:00.000-07:00

Some hospitals in Canada will soon charge pregnant patients to identify the sex of the fetus. A fee of 50 Canadian dollars will be charged if the sex of the baby can be determined. If the sex cant be determined, the fee will be refunded. It is interesting to note that the sex will not be mentioned by the Sonographer, but will be part of the official Radiologists report to be sent to the patient's physician. The sex of the baby will only be revealed after the patient completes her 20th week of pregnancy. This is done primarily to thwart abortions by patients unhappy with the sex of the fetus. In India and China, many female babies are aborted because of social stigma associated with having females.

"The College of Physicians and Surgeons is against fetal gender determination for non-medical purposes on the grounds that they may violate the principle of equity between males and females and may set a precedent for "eugenic decisions that are socially repugnant."

Read more: http://www.vancouversun.com/health/Bring+credit+card+pregnancy+ultrasounds+want+know+girl/3011258/story.html#ixzz0oOBIb2vx

Thyroid Biopsy With Ultrasound

2010-05-05T08:07:00.000-07:00

When performing fine needle aspiration (FNA) of the thyroid under ultrasound guidance, it is difficult for the physician to know if the specimens are adequate to diagnose the characteristics of a nodule without guidance from a pathologist. Specimens must be fixed immediately, and correctly for the diagnosis to be made. I found an article addressing ways to limit the number of failed biopsy's, thus limiting the need to call a patient to come back in for a repeat procedure.

Requests for ultrasound-guided biopsies for the diagnosis of thyroid nodules have increased rapidly in recent years, putting a strain on radiology departments everywhere," said Wui K. Chong, MD, lead author of the study. Unfortunately, there are a number of inadequate biopsies (where the pathologist deems there is an insufficient amount of information to make a diagnosis) that ultimately must be repeated.

http://www.physorg.com/news192269487.html

Attiva May Combat Obesity

2010-04-22T13:06:00.000-07:00

A new way of treating obesity has been unveiled recently, but it is a pill without a drug in it. The pill is known as Attiva, and it promises to curb the appetite by fooling the stomach into thinking it is full. By taking the pill with a glass of water, the ingredients in the pill absorb the water and swell up filling the stomach. The full stomach signals the patient with the "All Full Sign" thereby reducing hunger cravings. I wonder if this concoction mixed with water is sonographically visible? We have used a cellulose solution for years as an oral sonographic contrast agent to visualize the pancreas.

Gelesis engineered a super-absorbent polymer – is it ironic that it’s derived from an unspecified food source? – that can be reduced to small beads about the size of a grain of sugar. These tiny polymer beads swell up more than 100 times over when introduced to water, kind of like those little sponges you used to play with in the bath. So when you down a pill with a glass of water, the capsule dissolves in your stomach and the hydro-gel beads begin to grow. In a few minutes you’re feeling pretty full, and that second Double Down from KFC is decidedly less attractive.

http://www.popsci.com/science/article/2010-04/obesity-pill-swells-your-stomach-making-you-full-you-even-start-eating

Intimal Media Thickness: Is The Time Right?

2010-04-20T11:25:00.000-07:00

Many health care providers have discussed various ways to screen patients for peripheral vascular disease (PVD) more economically and effectively. I have been watching the debate concerning a technique that uses high resolution ultrasound now for about 6 years. Measuring the intimal media thickness (IMT) in the distal common carotid artery is a promising way because the abnormal thickness of this artery correlates with other forms of PVD to include the coronary arteries of the heart. What I have not seen is a "Gold Standard" criterion on which to accurately classify a patients risk of adverse cardiovascular events to include heart attacks. Recent articles are encouraging me to watch this area of research with a keen eye. We may be close to a workable criterion that will be accurate for most people regardless of outside factors (Race, environment, diet, and other risk factors). Insurance companies are interested in this technique also because it promises to lower the cost of screening for CV disease. Please note the link below.

"Today, up to 70 percent of people who have heart attacks are in a low or intermediate risk category for a heart attack when their risk is estimated using traditional risk prediction models. That’s not very predictive, and we need to do better," said Dr. Christie Ballantyne, director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart & Vascular Center and Baylor College of Medicine in Houston and last author on the study. "Our research shows that a noninvasive ultrasound can give us a more complete snapshot of our patients’ risk, so we can do a better job determining if they’ll have a heart attack."

http://www.physorg.com/news189789340.html

Doctor aborts wrong fetus

2010-04-16T08:53:00.000-07:00

A woman elected to have an ultrasound guided abortion on a fetus that was determined to be genetically damaged. The woman was pregnant with twins, and the goal was to abort the damaged fetus, but allow the normal fetus to continue to develop. The physician had little experience performing the procedure, and blamed "poor" ultrasound equipment for aborting the healthy fetus rather than the damaged fetus. The physician was stripped of his medical license.

"I have never, ever in my entire career ever said 'no' to a patient," he told the Times Monday, noting he told the couple of his inexperience in performing the procedure. "And that was my downfall."
See the story here courtesy UPI
http://www.upi.com/Top_News/US/2010/04/13/Doctor-removes-wrong-fetus-loses-license/UPI-83101271168998/

Bladder Flukes?

2010-04-13T08:21:00.000-07:00

I received a very interesting letter this morning from a student of mine. I will post part of it here: "I attended your course in Houston a couple of months ago and have a question. I was in Belize performing ultrasound using a Sonosite portable machine in March. Several of the women had some type of fasciculating / flagellating thing in their bladders. They seemed to be adherent to the bladder wall and be from 1 to 3 cm in length. I also saw a larger bladder tumor and a couple of kidney masses.

Is it possible to see Schistosomal "bladder flukes" in the bladder on ultrasound? I haven't found a reference for it."

Thanks,

Dr DS

I did a search on this topic, and came up with pretty interesting hits. Most flukes attack the liver, gall bladder, and gastro-intestinal systems in humans. I found very little on urinary bladder parasites. Certainly it is possible to have bladder parasites, and schistosomal infections are rampant in third world countries. I have never seen an image of a urinary bladder parasite on an ultrasound. If anyone has further information along these lines, including sonograms of parasites, I would be interested in talking with you. Thanks in advance!

Cairo MEDICON 2010

2010-03-31T08:11:00.000-07:00

Folk's we made it to Egypt. We are at MEDICON 2010 preparing to deliver a lecture with hands-on teaching on critical care ultrasound. We are amazed at the sights and sounds of one of the most ancient places of humanity on earth. The cab rides are better than an amusement park ride, and perhaps more dangerous. The wonderful people of Egypt have welcomed us with open arms and we have established friendships in the course of conducting business. Our goal is to bring modern ultrasound to the middle east nations, and this is certainly a logical place to begin. Our hosts have been gracious, the food a splash of color on the western palate. I am certain we will be back. We intend to wrap things up this weekend with a trip to the most magnificent structures on the planet. I am certain I will be humbled when I journey to the great pyramids of Giza. My companions have expressed an interest in riding a camel. I will pass, though I may ride a horse from west to east at dawn in a tourist encounter many of you have experienced. Hey. I am always the seeker of enlightenment. We will then discover the art of purchasing goods from a "Souk". I must not return home without a few gifts. I will be back soon with more news regarding this thread. Shalom!
Gizz

Egypt Here We Come

2010-03-22T09:49:00.000-07:00

I will be traveling next week to Cairo, Egypt to present a lecture and workshop in critical care ultrasound. This will be our first trip to this ancient land, and I am looking forward to the trip. We plan to visit the pyramids and maybe some museums along the way. I will post some images here when we get home. Details of the conference can be found here: http://www.aheconline.com/mediconex.html http://www.mediconex.net/

Therapeutic Ultrasound at home?

2010-03-22T09:31:00.000-07:00

Therapeutic Ultrasound has long been a means of treating muscular and bone pain. Often times, patients would be scheduled to come in for multiple sessions before pain management becomes effective. This can significantly impact a patients life in that many hours are spent in the hospital, or Doctors office waiting for treatment. A new device is being tested that could allow patients to take the ultrasound device home with them and administer there own treatments saving both time and money.
March 19, 2010

View a webcast with George K. Lewis, a biomedical engineering graduate student at Cornell University.
Imagine that after long day tending to patients, a middle-aged nurse feels a burning pain in her knees so intense she can barely walk. For millions of people who suffer from arthritis or other chronic joint pain, this is a familiar story. Right now there are few day-to-day therapies available for these patients, and many involve strong medications that can be harmful over time. Read more... http://www.nsf.gov/news/news_summ.jsp?cntn_id=116640&org=NSF&from=news

Elastography

2010-03-12T07:55:00.000-08:00

I have been watching with interest the development of new technologies in the field of ultrasound for over thirty years. Mile stones I have witnessed include real-time ultrasound (as opposed to B-scanning), color Doppler, 3-D ultrasound and portable high resolution ultrasound machines. A few years ago, one of our part time instructors told me of work her husband was doing in a relatively narrow field of ultrasound called elastography. She said that her husband's research indicated that ultrasound can be used to judge the elastic properties of abnormal superficial tissues, and that the relative stiffness of these lesions can be a predictor to whether the tissue is benign or malignant. Many skin and breast cancers become very hard, fixed and stiff compared to the surrounding normal tissue. Year later, research has proven her words to be true. Many papers have been published regarding the use of elastography in the evaluation of skin lesions, and breast masses. This science has now gained a foothold in clinical use to the point where many ultrasound manufacturers are adding the hardware and software needed to allow their equipment to be used in this manner. The benefits? One obvious benefit is we now have an accurate means of evaluating suspicious breast and skin lesions to allow us to reduce the number of biopsies performed. In the past, we routinely biopsied many masses based on fuzzy parameters in the hopes of avoiding litigation for missing a malignancy. We now have more accurate means to categorize lesions based upon stiffness, which raises our confidence level in establishing benign versus malignant without resorting to invasive biopsies. I will post links to a couple of articles written last year which discusses some specific uses of elastography.

"About eight of every 10 breast biopsies turn out to be benign. Elastography can better distinguish between benign abnormalities and cancerous breast lesions and keep unnecessary needle biopsies from ever taking place, said Dr. Stamatia V. Destounis, a diagnostic radiologist at Elizabeth Wende Breast Care in Rochester, NY."

http://www.diagnosticimaging.com/ultrasound/content/article/113619/1492190

"Tuesday at the 2009 RSNA meeting Siegel unveiled results of a study that, for the first time, looked at the utility of ultrasound elastography for identifying skin cancers.

Findings suggest that high-frequency ultrasound with elastography has the potential to measure the extent and depth of skin lesions as well as reduce the number of unnecessary skin biopsies."

http://www.diagnosticimaging.com/ultrasound/content/article/113619/1492835

Enjoy

Ultrasound and CT: The Debate Continues

2010-03-11T09:39:00.001-08:00

Many Americans are aware of the debate raging over the safety of CT scans performed. Issues regarding high radiation doses and appropriateness in the clinical setting have surfaced in recent months through out the media and in the blogosphere. The science behind radiation is clear: there is no such thing as a safe X-Ray. Medical professionals are taught in school that diagnostic X-Rays are to be used in the clinical setting when other, less hazardous forms of medical imaging will not give us the information we seek. Then why is it that when we go to the ED with an stomach pain we are sent to the CAT scanner instead of given an ultrasound? The answers are complex and troubling. In many cases the Physician trusts the result of the CT scan over the result of an ultrasound because they think the CT scan "Cannot miss anything". Many Physicians are under the impression that an ultrasound test is very operator dependent (True) and are loathe to trust the results for fear of being held liable if the test misses something. As a Sonographer, I agree that the results of the sonogram can be influenced by many factors including operator training and the skill of the interpretation, patient body habitus, and type of equipment used, but is CT really the gold standard? Should we really be subjecting our children and women of childbearing age to the risk of X-Rays without giving the matter much consideration? I would like to post part of an article I found on the web that discusses one of these issues. I welcome your feed back.

ScienceDaily (Mar. 8, 2010) — In a bold, eye-opening editorial in the March 2010 issue of the Journal of Ultrasound in Medicine, Harvard Professor, Beryl Benacerraf, MD, urges the medical community to use ultrasound instead of Computed Tomography (CT) as the first-line imaging test for better diagnosis capability in the evaluation of acute female pelvic and lower abdominal conditions.

"How have we evolved to ordering the most expensive imaging technique first for these patients, only to be followed frequently by a far less costly ultrasound examination to clarify the CT findings? Ultrasound is the established modality of choice to evaluate the female pelvis, so why do patients with pelvic masses or pain get a CT scan? In my opinion, doing a CT scan first for female patients with lower abdominal pain is dangerous and wasteful, a drain of much-needed health care dollars."
You can find the article here: http://www.sciencedaily.com/releases/2010/03/100302123122.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29

Thank you Science Daily.

First in Texas

2010-03-09T04:22:00.000-08:00

I am pleased to announce I am the first Sonographer in the state of Texas to use the GE portable ultrasound machine. As you see, it is slightly larger than an I phone, and a wee bit heavier. My GE medical rep, Mr S. Potter brought the instrument over to my office for a test drive yesterday. First Impression: Nice images. Very clear echocardiogram. Nice frame rate, and color flow Doppler that was pretty darn good. No pulse or CW Doppler. Only one sector probe. Three presets: OB, ABD, and Echo. One issue: it got very warm after 10 minutes of scanning, and automatically put itself in an energy saving mode (Wonder if that is connected to the heating???) The energy saving mode reduced the frame rate to 3 hertz. All in all, a great product for a quick look see. More later. Peace....

Contrast and Molecular Imaging with Ultrasound

2010-03-06T10:39:00.000-08:00

An exciting application of ultrasound contrast technology has been recently presented which uses molecular interactions between gas filled contrast agents tagged with substances that bind to tumors. This is exciting because we may be able to spot cancers while they are very small, and treat them before they spread.

"ScienceDaily (Mar. 6, 2010) — An imaging technique combining ultrasound and specially modified contrast agents may allow researchers to noninvasive detect cancer and show its progression, according to research published in the March issue of The Journal of Nuclear Medicine (JNM). The technique enables researchers to visualize tumor activity at the molecular level." Please see the full post here: http://www.sciencedaily.com/releases/2010/03/100301102751.htm

Thanks Science Daily. I hope further research is fruitful in this area. This seems like it may be applicable to many types of cancer, and perhaps, other diseases.

Editor

ED Physicians Ultrasound Test Available

2010-01-08T07:50:00.000-08:00

The American College of Emergency Physicians (ACEP) http://www.acep.org/ has published an on-line self test for emergency physicians to take when they are ready to document that they are proficient in the use of ultrasound in the practice of emergency medicine. This is the first test that I know of to address the issue of self credentialing. I took a few modules of the test myself (I passed) and found the test to be challenging, though I have been practicing ultrasound for many years as a Sonographer. The modules are of the multiple choice form with embedded videos that one may click on for clarification. One should read the question carefully before answering as the question itself can be confusing. I found at least two wrong answers listed as the correct response. For example: a patient is NOT routinely placed in the PRONE position to image the gall bladder. I am sure these issues will be ironed out. I do believe this is a great first step in beginning a standardized pathway for ED physicians to obtain self credentialing at the institutions where they are employed. Currently, there is no charge for taking the test, and results can be printed out. Here is the link: http://emsono.com/acep
Thanks Dr Morale

Pneumothorax by U/S?

2010-01-05T09:24:00.000-08:00

Recently,methods have been published outlining a technique for identifying moderate to sever pneumothorax using high frequency ultrasound. This technique is time saving and rather simple to perform at bedside and has been embraced by many ED Physicians in the trauma department. It involves looking for the presence or absence of a sliding lung using intercostal technique. Below is a link to one paper discussing this exciting new application of diagnostic ultrasound. Happy New Year.

Article Title: Sonographic Detection of Pneumothorax by Radiology Residents as Part of Extended Focused Assessment With Sonography for Trauma
Authors: Olga R. Brook, MD, Nira Beck-Razi, MD, Subhi Abadi, MD, Janna Filatov, MD, Anat Ilivitzki, MD, Diana Litmanovich, MD and Diana Gaitini, MD

A recently published article in the Journal of Ultrasound in Medicine assessed the accuracy of sonographic pneumothorax detection by radiology residents as a part of extended focused assessment with sonography for trauma (eFAST).

A sonographic search for pneumothoraces was performed as part of a standard FAST examination by the on-call resident. Each lung field was scanned at the second to fourth anterior intercostal spaces and the sixth to eighth midaxillary line intercostal spaces. A normal pleural interface was identified by the presence of parietal-over-visceral pleural sliding –“lung sliding sign”. Absence of lung sliding and comet tail was presumed to be indicative of a pneumothorax.

The sonographic diagnosis was correlated with supine chest radiography and chest CT. A total of 169 patients were included in the study. Chest CT was considered the reference standard examination. CT chest identified 43 pneumothoraces (13%): 34 small and 9 moderate.

On chest radiography, 7 pneumothoraces (16%) were identified. Extended FAST identified 23 pneumothoraces (53%). Compared with CT, eFAST had sensitivity of 47%, specificity of 99%, a positive predictive value of 87%, and a negative predictive value of 93%.

All of the moderate pneumothoraces were identified by eFAST. Twenty small pneumothoraces missed by eFAST did not require chest tube placement during the hospitalization period.

The authors concluded that the eFAST exam for detection of pneumothoces is an accurate and efficient tool for detection of clinically significant pneumothoraces. However, small to moderate pneumothaces may be missed.

To read full abstract go to:

http://www.jultrasoundmed.org/cgi/content/abstract/28/6/749

Thank You Sonoworld for the link

In Other News..

2009-06-05T07:45:00.000-07:00

WOW, summer is upon us. Where did this year go? I finally have some office time in between catching planes and avoiding catching the swine flu so here are some things I need to post.

First off, this blog has been honored by being listed on "Top 50 Radiology and Sonography Technician Blogs". I am indeed honored. Thank you so much Suzane. http://radiologytechnicianschools.net/top-50-radiology-and-sonography-technician-blogs/

Next I would like to mention that I am a member of the International Contrast Ultrasound Society. "As the world’s only professional society exclusively devoted to contrast-enhanced ultrasound (CEUS) medical imaging technology, we at ICUS hope to bring together professionals from form around the world in the fields of cardiology, radiology, vascular medicine, gastro-intestinal medicine, oncology, and other medical specialties." I would encourage all ultrasound professionals to become a member and support efforts to encourage the American FDA to allow ultrasound contrast agents to be used in applications other than echocardiography. www.icus-society.org <http://www.icus-society.org/

Sonoworld has some great new video lectures devoted to ultrasound contrast. William R. Lees, MD "Contrast Enhanced Ultrasound in the Abdomen" is a four part lecture that I watched this morning. It is very well done, and introduces us to CEUS in the abdomen, and other anatomical areas. It includes some discussion regarding the physics of ultrasound contrast, and some of the great applications being used in many other countries. This lecture centers around it's use in categorizing liver lesions, and compares the ultrasound findings to CT and MRI. Certainly the FDA is interested in bringing down the cost of health care without sacrificing quality? Sonoworld has many more lectures on a variety of subjects. http://www.sonoworld.com/

I would also like to announce that The Advanced Health Education Center has started a YOUTUBE channel for health care providors including sonographers. AHEC (my employer) will be posting videos and links in the future of interest to all medical imaging specialists. You can see the channel here: http://www.youtube.com/user/AHEConline

You can also link up to AHEC for CME's http://www.aheconline.com/

Peace, Gizz

Ultrasound and Big Brother

2009-05-08T09:14:00.000-07:00

Sorry folk's...The image to the left is a CT scan of a fish sandwich in the box from the local burger joint. I had to post the picture because it is so cool! If you have been keeping up with medical technology lately, you may have noticed we have some pretty cool medical image devices available to look into to the human body. So what does that have to do with the title of this post? Well, as we all know the new administration has promised an over-haul in the medical business. They promise health care will be available and affordable to all Americans. America is famous for using the latest technology in our hospitals and clinics. Some would argue we over utilize the most expensive scanners. I feel like ultrasound is going to profit from the lean times ahead because it is a very useful and cost effective modality.
Further more, ultrasound is being used in more and more ways to benefit the patient, and saving money at the same time. Here is a snippet from Daniel Merton's excellent article regarding the future of ultrasound: "Since its introduction in the 1950s, diagnostic medical sonography (DMS) has experienced periods of rapid technological advances that spurred intense growth in its clinical utilization. However, for the past several years it seems like the modality has fallen out of favor with imaging professionals-namely radiologists who prefer reviewing films in a dimly lit reading room over holding a transducer-as well as referring physicians who have become more reliant on the diagnostic potentials of MRI and CT."

http://imaging-radiology-oncology-technologist.advanceweb.com/editorial/content/editorial.aspx?cc=198582

Stay tuned for more on this subject.
Peace, Gizz

The Struggle Continues

2009-04-13T07:30:00.000-07:00

As we move into the this new year it is interesting to note that the FDA is still grinding it's heels over the ultrasound contrast issue here in the USA. AIUM just wrapped up it's meeting and I will post some highlights:

"Contrast-enhanced ultrasound was a much-talked about topic at the event since it holds great promise. "At the moment, we do have a problem in the U.S. The FDA has approved only two agents for cardiac microbubbles," Dr. Kurtz said. He noted that clinical opinion leaders are talking to the FDA through a multi-specialty task force with vendors to urge further approvals. "The world has access to ultrasound contrast agents; we [in the U.S.] have only limited access," he said, noting its applicability to examining the spleen, liver, and vascular anatomy. Meanwhile, elastography has recently been developed and is being refined to enhance characterization of tumor tissue, also a method applicable to examining liver disease such as chronic hepatitis."

http://www.dotmed.com/news/story/8739/

I hope the FDA can come to it's senses pretty soon. The rest of the world embraces ultrasound contrast media. Why can't we?

Peace,

Gizz

FDA Removes Black Box Warning

2008-06-13T10:43:00.000-07:00

The FDA has removed the black box warning on DEFINITY, an ultrasound contrast agent used in the USA to enhance echocardiograms. HURRAH!

According to an on-line press release on the web site for Lantheus Medical Imaging, Inc., the United States Food and Drug Administration has agreed to allow important changes to the product labeling for ultrasound contrast agents (UCAs). Lantheus Medical Imaging markets the UCA DEFINITY®. In October of 2007 the FDA mandated that Definity and other UCAs carry a “black box warning” as a result of complications in some patients (see previous report ). The 2007 warning required monitoring of all patients who received contrast injections. Many members of the ultrasound community, particularly those in the echocardiography community, felt that the FDA’s labeling requirement was unwarranted and would adversely impact patient care. Now, based on safety information provided to the FDA by both Lantheus and members of the medical community, the boxed WARNING and WARNINGS sections of the Package Inserts have been revised, most notably to require monitoring of only patients with pulmonary hypertension or unstable cardiopulmonary conditions. Similar label updates have been approved by the FDA for all perflutren-containing microsphere contrast agents. Lantheus Medical Imaging will host a webcast for healthcare providers to provide an overview of the new Package Insert. For information on the webcast call 1-800-343-7851.

http://www.lantheus.com/News_05062008.html

Peace, Gizz

Something Old, Something New

2008-03-13T06:43:00.000-07:00

Greetings,

I was going through some articles and mail this morning and found a peice written last year in Science Daily regarding targeted delivery and micro-bubbles. I think it would be beneficial to post it again.

ScienceDaily (Jul. 13, 2007) — A new targeted drug delivery method uses ultrasound to image tumors, while also releasing the drug from "nanobubbles" into the tumor, according to a study published online July 10 in the Journal of the National Cancer Institute.

http://www.sciencedaily.com/releases/2007/07/070711143204.htm

One other post from the ARMDS newsletter is worthy of a read concerning a new form of ultrasound technology designed to screen out reverberation artifacts. The authors claim this will allow better screening for small tumors of the prostate, breast and thyroid among other things. The article is translated (supposedly) from Dutch. It will be interesting to see which manufacturer snaps this new technology up.

ScienceDaily (Mar. 4, 2008) — New ultrasound technology will make it possible for doctors to discover cancer tumors far earlier than before. A method that transmits new and more advanced ultrasound signals is being tested in Trondheim. The chances of discovering and diagnosing tumors in the prostate and breast are expected to improve significantly.

http://www.sciencedaily.com/releases/2008/02/080229132251.htm

Peace, Gizz

Intracranial monitoring with ultrasound

2008-03-03T08:45:00.000-08:00

Greetings all,

I new interest in intra-operative monitoring during enarterectomy is re-visited. I will post a couple of interesting links.

A-Mode Echoencephalography

Eric Blackwell, MD OBGYN.net Editorial Advisor

"I would like to share with you a few words about the use of a-mode ultrasound (echoencephalography) at Bowman Gray. My training began several years before the ready availability of computed tomography in the emergency center setting. An early application of ultrasound was for rapid screening of trauma and stroke patients for intracranial mass lesions. The underlying concept was that a-mode ultrasound could be used to identify structures normally located in the midline of the brain such as the third ventricle and falx cerebri."

http://images.google.com/imgres?imgurl=http://www.obgyn.net/us/news_articles/ultrasound_history/A-mode_technique.jpg&imgrefurl=http://www.obgyn.net/us/news_articles/ultrasound_history/US_history_A-mode.htm&h=407&w=600&sz=53&hl=en&start=17&sig2=vj0pKnbJv3plV88QJxzqNw&tbnid=PeacUr2MPw4iNM:&tbnh=92&tbnw=135&ei=kyvMR7rIMpWIiwGGlYSIDg&prev=/images%3Fq%3DIntracranial%2Bhemorrhage%26hl%3Den%26rlz%3D1T4GFRC_enUS205US206

The second reference is from the ARDMS newsletter.

" New techniques for detecting harmful blood clots and air bubbles in arteriesNew techniques for detecting emboli have played a major role in dramatically reducing stroke rates after carotid edarterectomy.New techniques for detecting emboli (harmful blood clots/air bubbles in arteries) developed at the University of Leicester have played a major role in dramatically reducing stroke rates after carotid endarterectomy. This is an operation designed to remove narrowings in the main arteries supplying the brain before they can cause a stroke."

http://view.ardms-email.com/view_email.aspx?j=fe9317797160077875&m=fefb11747d6407&ls=fdf9157876640d7477147170

Peace,

Gallgizzard

Let's Shake Rattle and Roll

2008-02-06T15:04:00.000-08:00

Hiyya folk's

Here we go. Science at it's best!

"Scientists may one day be able to destroy viruses in the same way that opera singers presumably shatter wine glasses. New research mathematically determined the frequencies at which simple viruses could be shaken to death."

As a Sonographer, I think this is great! Let's see what we can do in the next 20 years with this idea. As the article says, laser or medical ultrasound can find the resonant frequency of atoms in a cell structure. I will say it takes a bunch of computing power to perform this stunt.

We are talking terabytes of processing power my freinds. Perhaps the people at Berkely can take time off from the SETI@ home, and can donate some time to grab info on the resonant frequency of individual atoms in a virus, or a bacteria. I love this article because it is a step in the right direction. Here is the link to the article courtesy Matt Drudge and Live Science:

http://www.livescience.com/health/080205-virus-shattering.html

I can see sonographers being called upon to treat a person in the dialysis lab. This may be a great thing in the science of treatment. Let's blow these suckers up (viruses), and allow our patients to get back to jobs, and families. See my previous post about contrast agents and ultrasound to put it all together. Go for it scientists!!

Peace,

Gizz

Stroke Treatment

2008-01-29T11:28:00.000-08:00

Greetings,

I have been very interested in the recent advances in targeted therapy using ultrasound contrast agents (bubble technology). It has been known for a few years that micro bubbles filled with gas can be safely administered IV to image many organs in the body using conventional sonography and harmonic imaging.

The idea of filling these bubbles with other medications along with the gas, and adding proteins to allow the bubbles to target specific tumors or clots is not new, and research continues along these lines. I am hopeful that in the near future, Sonographers may be intimately involved in treatment as well as diagnosis of conditions likely to respond to this form of targeted delivery.

As an American, I am very disturbed by the FDA's decision to black box Definity and Optison; agents used to opacify the heart for wall motion abnormalities. In the EU, ultrasound contrast has been safely used for years for evaluating liver lesions, trauma, echocardiography, and vascular imaging. Contrast is only approved in the USA for LVO (left ventricular opacification). I find this extremely disturbing. Many cardiologists are protesting this black box warning because of flawed evidence concerning a very minor number of events where contrast was a party to the treatment or evaluation of the patient.

I register this protest because the potential life saving benefits that ultrasound contrast has to offer outweighs the potential negative side effects. The FDA has made a very poor case regarding the black box warning, and the ultrasound community is responding. The potential future benefits of contrast in the ED, and in routine imaging are limitless in my opinion.

Uses in the EU include:

* Trauma and organ damage with bleeding due to trauma

* Ischemia to almost any organ

* Perfusion surveillance (kidney transplants, etc)

* Torsed testicles or ovaries

* Lesion categorization in the liver and other organs

* Differentiation of clot from living tissue/tumor

These are routine uses in the EU. Why the hell is the USA balking at adding contrast to our vast arsenal of life saving drugs? My guess is political and financial manipulations. It is always about the money.

Here is an interesting discussion about one companies struggle to produce an agent with potential to treat stroke patients:

ImaRx Therapeutics, Inc. recently issued a progress report on its TUCSON (Transcranial Ultrasound in Clinical SONoLysis) United States Food and Drug Administration clinical trial involving patients with acute ischemic stroke. TUCSON is a randomized, placebo controlled clinical trial to evaluate the safety, tolerability and effectiveness of a ImaRx’s microbubble-based agent MRX-801. Administration of MRX-801 and ultrasound imaging is being used as an adjunctive therapy to the conventional method of administration of tissue plasminogen activator (tPA) for treatment of two different cohorts of patients with acute ischemic stroke.

www.sonoworld.com

Take care,

Gizz

Job Security

2008-01-12T03:21:00.000-08:00

Greetings gentle readers,

I saw patients yesterday for the first time this year at a great hospital. I had a horrible case that I will will never forget involving a kindergarten teacher. Tune in next week for that one.

Right now I want to give "Thanks" for obesity.

"Self indulgence is the product of prosperous society" I paraphrase one writer who tips the scales over 350 pounds.

As a Sonographer, I say it is job security. How many times are we called to the ED to R/O DVT, or gallstones in the obese? We may grumble, but it pays the mortgage. The following link describes one person's latest diatribe about the greatness of being obese.

WASHINGTON (AFP) - As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.

Burps... Gimme a break

"Obesity is a natural extension of an advancing economy. As you become a First World economy and you get all these labor-saving devices and low-cost, easily accessible foods, people are going to eat more and exercise less," health economist Eric Finkelstein told AFP."

http://news.yahoo.com/s/afp/20080110/hl_afp/lifestyleushealthobesity_080110170913

As a sonographer, I know that part of my job is taking care of the obese. I never council people on their eating habits because that is not my job. I must point out that from an ergonomic point of view, treating the obese is a challenge to my aging body. The techniques of imaging the "TDS" patients are much different from other studies. We all groan when reading the height and weight of a patient on a request: 380 pounds, 5'1", and wish we could slap that request back in the box.

Never you mind though, as the post says, obesity is here to stay. I call it job security.

Peace,

Gizz

This kind of emergency is too common...

2008-01-04T13:48:00.000-08:00

Greetings,

The following is from an emergency physicians BLOG posting which happens quite a bit in the ED.

" Last night in the ER...
....was very busy. And "busy" in a good way. Lots of codes and respiratory distress. Not so much "weak and dizzy" and "TMD (todo me duele)". The kind of night that reminds you why you chose emergency medicine as a specialty, and not primary care.
Anyhoo, there was this one guy...
A 36 yo morbidly obese Samoan man with a past medical history of diabetes, hypertension, and has lots of 'bad habits', was brought in by paramedics complaining of chest pain which started 10 minutes prior to the 911 call. He was sitting on the sofa watching reruns on TV when he suddenly felt a tightening in his chest. He got up to get a cup of water, and the pain got worse. Then he felt weak and lightheaded so he sat down on the nearest chair. He then called for his wife, and she took one look at him and called 911.
In the field EMS established a very tiny finger IV (because 'his veins could not be accessed secondary to excessive adipose tissue.' i.e. he was too fat). They gave him an aspirin, and after he denied using Viagra, a nitroglycerin sublingual. Immediately thereafter his blood pressure dropped from 150s systolic to low 80s. He became very diaphoretic (lots of sweating), and short of breath.
Upon ED arrival the patient was alert and oriented, but very agitated sitting upright on the gurney, in moderate/severe respiratory distress. He weighed about 450 pounds, and was extremely diaphoretic, and c/o worsening SOB. EKG could not be obtained by the paramedics because the stickers wouldn't stick to the body for all the sweat. Also, the patient was so agitated and anxious that a good reading couldn't be obtained even when the EKG leads were held in place by assistants.
In the ED we attempted to obtain an EKG...for over 20 minutes. We cannot make a diagnosis of acute MI requiring thrombolytics if we cannot obtain an EKG. Afterall, there are other deadly causes of chestpain, some of which absolutely cannot be treated with thrombolytics (or else you kill the patient). It's one thing for someone to die. It's another thing to kill them. So we worked to obtain that EKG...over, and over, and over, and over again.
During this time we worked to establish a better IV with ultrasound guidance."

Here is where I need to jump in. Ultrasound is very useful for line placement and other procedures. I teach ED physicians line placement procedures at my school. We practice on phantoms instead of real human volunteers, and the procedure works well for subclavians, and other veins when obesity or other issues arise making placement difficult.

I would also be called in to perform an echocardiogram in a situation like this (where getting the EKG is problematic) to look at basic cardiac function, and try to see if there were any heart wall motion abnormalities. Granted in this patient the echo would not be very diagnostic, but it would be worth a try. I also train ED physicians to perform basic echocardiography useful in cases like this.

More often than not, I would also be called upon to look for DVT if the patient were in respiratory distress, but even this procedure is difficult in the morbidlly obese. Just some thoughts for a cold January day. To continue with the article please click on the link below.

http://emphysician.blogspot.com/

Have a great day,

Gizz

Prison, not a healthy place to be

2007-12-30T16:41:00.000-08:00

Greetings gentle readers.

First off some business. My previous BLOG was on YAHOO. I cannot post there anymore for some reason. Go to YAHOO and search the YAHOO tool button search engine for me, gallgizzard.

Next: My Blog here is hard to find. it is wwwsonographersblog.blogspot.com Please do not put a period between the www and the S.

And finally, the pic on the left was taken by me during the evacuation of Houston, TX during Rita. My family and myself stuck in traffic with thousands of people on highway 59-N. We made it as far as Bush Airport (22 miles from my home). It took us 18 hours to make it this far.

We turned around at this point because we were low on gasoline (Petrol), and our pet's were in danger of dying. It was a hot day as you see.

One other note: I am having format issues. My line breaks are not showing up well on the blog. I know how to write, but this blog engine is not treating me nice. I apologize for the un-organized posts. I will send a note to blog.spot, but they are all off flying ultralights and drinking silly stuff at the moment.

Here is my post:

" COALINGA, Calif. — When any of the 5,300 inmates at Pleasant Valley State Prison begin coughing and running a fever, doctors do not think flu, bronchitis or even the common cold.
They think valley fever; and, more often than they would like, they are right.
In the past three years, more than 900 inmates at the prison have contracted the fever, a fungal infection that has been both widespread and lethal.
At least a dozen inmates here in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths. "

TY Matt Drudge, here is the link: http://www.nytimes.com/2007/12/30/us/30inmates.html?ei=5065&en=2a4f9cfb43da0bcc&ex=1199595600&partner=MYWAY&pagewanted=print

Gosh, this editor is nasty, I cannot get a paragraph break in here. I am so sorry! Help me Google!

This writer wants to state that people should be wary of closed places. This includes nursing homes, sports centers, malls.. anywhere people are crowded around. This new disease (maybe not new, perhaps ancient) is a fungus. I would be willing to entertain other comments on this. Perhaps there are other sonographers who have some findings to share. Echo, abdominal ultrasound findings. Let's see how this disease presents on ultrasound.

Peace,

Gizz

Thyroid Patient

2007-12-29T13:37:00.000-08:00

Greetings Gentle Readers,

Yes, this is the same ole' Gizzard posting. I have a quick story to tell. I had a young student a few years ago attend one of my classes on abdominal ultrasound. We cover everything in the belly, then some. The "then some" involves discussions about small parts, thyroid, and testicular imaging (another post to come). In day five we cover superficial sonography to include masses , lymph nodes, muscular tumors, and thyroid sonography.

As usually happens, the students scan each other in the lab on the great machines we have, and damned, if I was looking over the shoulder of the neophyte when I spotted a heterogeneous lesion in a students thyroid gland. I say "no big deal"to the person on the gurney, and no big deal to all who gathered rapidly (my utterance rang like a monastery chime in a mountain retort in the Himalayas). DING DONG!!!!!

Arrgh.

Medical Dilemma. It looked like the throngs of unwashed hanging about after a car bombing. But these people could hear! BONG BONG!

One word of advise to junior sonographers, never say OMG or WOW in front of a patient. They will look at you with the eyes of lasers (and my cat) and say "What did you find?". Many patients watch the eyes of a sonographer instead of the screen which they think looks like a snowstorm (1965 TV set on channel 2).

Gizz Note: did you know that it was once thought a tornadoe could be predicted by listening to the pattern of white noise on a TV set? Please look that one up for me folks.

I proceeded to tell the group about the mass seen on the screen with attention directed to it's grey-scale features, all the time smiling and tapping my toes lightly.

By the literature, the vast majority of lesions in the thyroid gland are benign processes, and should cause little concern. I preached this to the audience who gave me the "fish-eye". I counseled the student who's thyroid lesion was clearly presented on the screen not to worry, but consult her doctor when she returned home. I always say this when ever an abnormality is seen in the classroom setting. I told her I am not a doctor and that it is up to her physician to decide what to do.

Sure enough, I get an E-mail the next week from this student telling me she did visit her physician, and they DID perform a biopsy and it WAS cancer. Wow, if I had any schnapps at the office, I would have taken a sip. I told her to stay in touch and God Bless.

It does not end here. She showed up a year later to take another class, and I got big huggz when she strode into class. Alas I do not always remember names, but I do remember faces, so I accepted the bear hug she dealt me.

I asked her about the surgery, and she said they did a total thyroidectomy. "They removed it all and gave you radiation chemo?" I asked

"No, they did not give me any chemo...."

What?...

"My Doctor did not want me to have Iodine 131 therapy because I told him I wanted children."

Here I must say dear readers, that most thyroid cancers which are deemed virulent, or aggressive are followed by radiation treatment consisting of a couple pills of a very radioactive form of iodine. This treatment requires the patient to be cloistered for at least 2 days in isolation because of the high levels of radiation emitted by the iodine (mostly beta rays which do not penetrate far). Clothing, food, tissues, bandages, all personal effects must be tossed after this form of chemo.

The idea here is to treat any remaining cancer cells with radiation. Iodine is taken up specifically by thyroid cells, thus is the best chemo agent for the task as it will hunt out aberrant thyroid tissue like a blood hound seeks an escaped criminal.

Here the story resumes. I say to her "Would you like for me to scan your thyroid bed for any thing extra?"

Of course you have figured out I found another mass. It was removed, and she did have radiation chemotherapy, only after delivering her healthy baby son.

By the way, the image you see above is one of my feline buddies I inhabit the house with. She just got a shower, and she is not pleased. And Yes, I will post her to lolcats.

Peace,

Gizz

Kindness

2007-12-26T03:59:00.000-08:00

Greetings gentle readers,

Tis' the day after Christmas, and all through my house, all the cats were purring, I could hear nobody grouse. I drove home yesterday from the in-laws alone because today I must get back to work. I am going to see some patients, though I doubt it will be busy because most people will be out exchanging gifts, or tryying to put together the new what-cha-call-it for the kids. I will pick up my family on saturday.

My kid got an amazing assortment of things from St. Nic, but the toy I was enthralled with was the motorized radio controlled car with a working video camera on it. He used it yesterday to check out all kinds of things on the sly to include the bathroom, the christmas tree late at night in hopes of catching Santa's visit, and of course he had to check up on everybody else. The good thing is, the car cannot open doors. Think PRIVACY folks.

In other news, I am still tweeking this forum (I changed the style) and I will be adding some "Elements" to include a feed-back page and other things.

As I prepare to see patients near NASA (an hours drive from me), I leave you with a link I hope you will visit http://www.chicagotribune.com/news/local/chi-pigeonman-feature_webdec19,0,4740879.story (Courtesy Chicago Tribune)

This link will take you to a very sweet story about an old man and his devotion to caring for animals which I thought you may like.

Peace,

Gizz

Working out the kinks

2007-12-23T04:49:00.000-08:00

Greets Gentle readers,

It is Christmas weekend, and yes I am going to do as much work on this BLOG as possible while taking care of family and freinds. This is a Sonographers BLOG as titled so lets get right down to it. I am a Sonographer. What the heck is that?

I perform ultrasounds.

Let's define a Sonogram. Its a medical testing procedure that lets us evaluate your unborn baby (DUH) and a lot of other things too. I specialize in Cardiac scanning, Vascular imaging, Internal Med, and I perform OB-GYN procedures. I am board certified in all the above.

Who certifies me? Am I a Doctor?

No I am not a physician, I am certified throught the ARDMS (American Registry of Diagnostic Medical Sonographers). www.ardms.org

So why should I care?

Simple, ARDMS Sonographers are the best of the best. They have demonstrated competance through intensive testing to know human anatomy, physiology, and pathology. The boards are a TUFF! I am glad I am through with them. I must continue my education by posting 30 category 1 CME's www.accme.org every three years. I will say that is a minimum number, and should be raised. The field of ultrasound is changing every day, and we Sonographers should be on top of every change by staying in touch with avenues of education.

Oh! Did I mention I am an educator?

Yes, I teach medical ultrasound. I teach in Houston Texas. Please come down for a visit

Merry Christmas from the Gizz!

2007-12-22T09:51:00.000-08:00

Greets gentle readers,

As you know, I have had a hard time with my previous BLOG. I have "dun it down". I will continue a presence on Yahoo, but it will be a small one. This first post is to establish a presence on Google Blog.

My family and I are headed out to a small town in south Texas for Christmas today. We do not look forward to the traffic and drunks. Please know that I will be posting more on this blog that has value than my Christmas trip. To my freinds, Merry Christmas. GO NASA!

I will continue to post things that are of value to the world.

God Bless you all!