In a veterinary trade journal, an ultrasound salesperson is quoted as saying “veterinarians need to know their ultrasound limitations, whether such limitations are due to their training, experience, or the quality of the ultrasound machine purchased.” Really? How exactly are veterinarians supposed to learn their limitations?
Knowing your limitations - example from the non-ultrasound world
In order to learn our limitations, we need to go to the edge and risk things OR be shown our limitations by a mentor. As an analogy, lets say you are new to a sport like cycling. You have no idea how far you can ride or how good you are relative to other cyclists. Every new cyclist learns their endurance limits by going on a ride that is too long for their fitness. Riding home when you are cracked or calling someone to pick you up is a painful way to learn your endurance limits. If you only rode alone all the time, you would also think you are a speedy superstar. If you rode with a group of pro level riders, you would be begging for it to end and likely get left for dead as the group rode away from you. In this situation, the group showed you your limits and acted as your mentor.
Knowing your limits in the ultrasound world - Residency training
The way radiologists learn their limits with ultrasound is by working with a mentor for several years during a residency. The mentor shows us our limitations by scanning side by side with us. When we miss lesions they tell us and we learn without harming any patients. This process takes several years and hundreds of animals. By the end of the residency we know our limitations1 and we are released into the wild.
Knowing your limits in the ultrasound world - The veterinarian in private practice
For the practicing veterinarian, there is no mentor in your practice scanning animals with you to let you know when you are at your limits of expertise and you are about to miss a lesion. Unfortunately, the only way to know your limits (just like when you crack yourself riding) and learn ultrasound is to either over diagnose and perform unnecessary abdominal exploratory surgeries or miss lesions and (at worst) kill your patients. Learning your limitations is painful. Unfortunately, without a mentor, this is what learning your limitations means.
Participation in veterinary ultrasound short courses is an essential part of learning ultrasound. However, these courses will not help you know your limitations. Getting back to our cycling analogy, these courses are more analogous to showing you how to ride a bike when you are a child. Just like you cannot learn how to trace a distended ureter in a short course, you cannot learn your limitations in a short course because all of the animals in a short course are healthy and learning limitations in ultrasound requires learning on animals with abdominal pathology.
Learning the limitations of your ultrasound machine is even more difficult if you have little or no experience with ultrasound. You will know when you miss a lesion because you will have a dead patient but how do you know the limitations of your machine when you do not have a machine to compare with side by side? During my residency we had several machines that I could use to compare side by side. In one dramatic case, one ultrasound machine identified splenic lymphoma while the spleen in another machine looked completely normal. Understanding the limitations of an ultrasound machine requires you to have extensive training on a very high end machine or have multiple ultrasound machines that you can use to compare side by side.
BOTTOM LINE: Despite the seemingly helpful comments made by ultrasound salespeople to “know your ultrasound limitations” understanding your limitations will require dead animals and/or unnecessary exploratory surgeries2. If you are not prepared for this type of learning, you will likely have an ultrasound machine sitting in the corner collecting dust.
__________________________
1. Truth be told – for me it took another 2 years after residency before I was confident enough to say that if I didn’t know something, likely nobody else would either.
2. Before you email me with the “you ivory tower, pompous radiologist who only thinks that specialists should use ultrasound” email please let me head you off at the pass as I am a big proponent that ultrasound should be present in every practice. The point of this article is to remind people that learning limitations (and ultrasound) is tough and you should be ready for the challenge before you take the plunge.
