Learning ultrasound is difficult and takes time. Unfortunately, ultrasound cannot be learned in a weekend short course AND teleradiology review of still images does not obviate the need for the hours necessary to learn ultrasound.
The problem with ultrasound education: The problem with veterinary ultrasound education is that veterinarians have been lead to think that it is possible to become a proficient sonographer by scanning a limited number of healthy dogs in a short period of time. Ultrasound education is a labor intensive process that requires motor skills and an understanding of pathology and anatomy. These skills simply cannot be adequately packed into a 1 or 2 day short course. Furthermore, in short courses, the only animals that are generally available for scanning are healthy animals.
Veterinarians have also been mislead to think that they can learn the pathology and nuances of ultrasound by sending still images off for teleradiology review. Thre is the impression that sending still images for review is similar to human medicine where an ultrasound technologist does the studies and they are reviewed by a specialist later. Contrary to the situation in veterinary medicine, human sonographers have a minimum of 2 years of focused ultrasound schooling coupled with 6 months of on the job experience. After identifying significant lesions in dozens of animals that were inappropriately managed by well meaning veterinarians and teleradiology consultants, it is clear that the current state of ultrasound education is inadequate.
Do we need to adjust expectations when shopping for an ultrasound machine?: When many veterinarians purchase an ultrasound machine they believe that they will become proficient sonographers at an ultrasound short course. They believe that they will need a machine that will have Doppler, echo, and ultrafine detail capabilities. These machines are expensive. What many veterinarians find is that the education falls short and they are not confident in their skills yet they must find a way to pay for the expensive ultrasound machine. Veterinarians may find themselves in a situation where they must order ultrasound studies to pay for the machines and/or not utilize the local specialists for complicated cases in order to pay for the machines. Failing to understand ones limitations in ultrasound will decrease the quality of medicine in the practice. One issue with ultrasound diagnosis, as with any diagnostic modality, is a clinician does not know, nor will they ever know, what they don’t see or recognize.
Conversely, some veterinary practices attempt to avoid this situation and simply go without ultrasound. This leaves many patients without access to ultrasound - even in emergency situations.
The solution: A new approach to veterinary ultrasound education is needed. The following is a 5 step solution will help improve veterinary ultrasound education and help veterinarians with their equipment purchases:
- Step 1: Understand that a veterinarian cannot learn ultrasound by scanning a limited number of healthy dogs in a short period of time. The current short courses should be used as a very basic introduction. Stated another way, after these courses, you will know enough to be dangerous. Finding an adrenal gland or pancreas is not equivalent to an adequate ultrasound examination. Ultrasound education is a long and arduous process that can be done by most any veterinarian with the time and effort – just not while scanning a few dogs on a Saturday afternoon.
- Step 2: Understand that ultrasound is dependant on the user and teleradiology is of no value if the user is inexperienced. Getting a “stamp of approval” by sending out still images for teleradiology review will make you feel more confident but does little to raise the quality of medicine in a veterinary practice.
- Step 3: Understand that 80% (a guesstimate) of the ultrasound studies that are performed in a veterinary practice are [for what I call] “The BIG ONES.” These are the conditions that need an ultrasound STAT. Referral is not a good option. These studies include, evaluation of large liver and splenic masses, free peritoneal or thoracic fluid, pericardial effusion, evaluation of the urinary bladder for stones; as well as aspirating free abdominal or pericardial fluid and obtaining urine samples by cystocentesis. The interesting thing is that these conditions are the easiest conditions to learn to manage with ultrasound and CAN be learned on a single Saturday afternoon. These conditions also comprise 80% of the studies that most veterinarians eventually learn to perform with ultrasound. Understanding that 80% of what most veterinarians will do with their ultrasound machine can be learned on a Saturday afternoon is important.
- Step 4: Understand that 80% of what most veterinarians do with their ultrasound machine does not require an expensive or fully featured ultrasound machine. Rather, the 80% of what most veterinarians do with their ultrasound machine can be performed on a lower end machine. Many machines that can perform this type of study cost under $20K.
- Step 5: Understand that every veterinary hospital needs an ultrasound machine and all veterinarians should know the basics. Many of our 80% of the cases are emergency studies and referring these cases for evaluation by a specialist may delay treatment and unnecessarily add expense to the patient evaluation.
In conclusion – The Johnson Manifesto: The Johnson manifesto states that every veterinarian should have an ultrasound machine in their practice. Veterinarians should understand that they cannot fully learn ultrasound by scanning a limited number of healthy dogs in a short period of time BUT they can learn how to do 80% of the studies most veterinarians will do in a weekend course and purchasing a less expensive ultrasound machine to achieve this goal is a very viable solution. Finally, additional expertise in ultrasound is certainly possible but will take time and effort that cannot be taught in a weekend short course.
For more informaton on this topic please visit www.aavr.org
* Eric Johnson DVM DACVR for first introduced this concept.
