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The Core Content of Clinical Ultrasonography Fellowship Training

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The Core Content of Clinical Ultrasonography Fellowship Training Appendix The Core Content of Clinical Ultrasonography Fellowship Training The following document details the resident level (Topics 1-18) and fellow level (Topics A1-A22) curriculum for Clinical Ultrasonography education. Each application description will include a scanning protocol, normal anatomy and pathology to be mastered and how to integrate into the clinical care of the patient. Table of Contents Resident Level Topic I. Focused Assessment with Sonography in Trauma .................................................................. 3 Jason Nomura MD Topic 2. Focused Cardiac Ultrasound ........................................................................................................... 8 Deborah Shipley MD and Christopher Moore MD Topic 3. Basic Thoracic Ultrasound ........................................................................................................... 13 Michelle Pearl DO Topic 4. Aorta Ultrasound ............................................................................................................................. 16 Karen Cosby MD and Caitlin Bailey MD Topic 5. Biliary Ultrasound ........................................................................................................................... 19 Joseph Minardi MD Topic 6. Renal Ultrasound ............................................................................................................................. 22 Rimon Bengiamin MD and Uche Blackstock MD Topic 7. First Trimester Ultrasound .......................................................................................................... 26 Gillian Baty MD Topic 8. Second/Third Trimester Ultrasound ........................................................................................ 31 John Gullett MD Topic 9. Deep Venous Thrombosis ............................................................................................................... 34 Beth Cadigan MD Topic 10: Inferior Vena Cava Ultrasound.................................................................................................. .37 Justin Ahn MD Topic 11. Soft Tissue Ultrasound ................................................................................................................ 40 Romolo Gaspari MD Topic 12. Ocular Ultrasound ......................................................................................................................... 43 Zoe Howard MD and Laleh Gharahbaghian MD Topic 13. Ultrasound-Guided Central Venous Access.......................................................................... 46 J. Matthew Fields MD Topic 14. Ultrasound-Guided Peripheral Venous Access ................................................................... 49 Robinson Ferre MD Topic 15. Ultrasound-Guided Pericardiocentesis ................................................................................... 51 Amanda Kao MD Topic 16. Ultrasound-Guided Thoracentesis .......................................................................................... 53 Robert Rogers MD Topic 17. Ultrasound-Guided Paracentesis ............................................................................................. 55 Robert Rogers MD Topic 18. Abscess Identification and Drainage ...................................................................................... 57 Robert Rogers MD and Romolo Gaspari MD Fellow Level Topic A1. Airway Ultrasound ....................................................................................................................... 59 Alan Chiem MD and Rimon Bengiamin MD Topic A2. Advanced Thoracic Ultrasound ............................................................................................... 63 Fernando Silva MD Topic A3. Advanced Cardiac Ultrasound .................................................................................................. 66 Christopher Moore MD Topic A4. Advanced Ocular Ultrasound .................................................................................................... 69 Kenton Anderson MD Topic A5. ENT Ultrasound.............................................................................................................................. 71 Bret Nelson MD Topic A6. Adnexal Ultrasound ..................................................................................................................... 73 Sandra Williams MD, Jennifer Carnell MD, and Stanley Wu, MD Topic A7. Uterine Ultrasound ....................................................................................................................... 77 Sandra Wiliams MD, Jennifer Carnell MD, and Stanley Wu MD Topic A8. Testicular Ultrasound ................................................................................................................... 80 Cecily Reynolds MD Topic A9. Advanced Abdominal Organ Ultrasound .............................................................................. 83 Sachita Shah MD Topic A10. Bowel Ultrasound ....................................................................................................................... 88 Timothy Jang MD Topic A11. Appendicitis ................................................................................................................................. 92 Katja Goldflam MD Topic A12. Intussusception ........................................................................................................................... 94 Lorraine Ng MD Topic A13. Pyloric Stenosis ........................................................................................................................... 97 Lorraine Ng MD Topic A14. Fracture Assessment ............................................................................................................... 100 Kenton Anderson MD Topic A15. Ultrasound of Tendon and Muscle ..................................................................................... 103 Joy English MD, Arun Nagdev MD, and John Bailitz MD Topic A16. Ultrasound of Joints ................................................................................................................. 107 Arun Nagdev MD Topic A17. Ultrasound of the Pediatric Hip .......................................................................................... 109 Jason Levy MD 1 Topic A18. Advanced Vascular Assessment .......................................................................................... 112 Matthew Chang MD and Eitan Dickman MD Topic A19. Ultrasound-Guided Nerve Blocks ....................................................................................... 116 Michael Stone MD Topic A20. Ultrasound-Guided Lumbar Puncture .............................................................................. 120 Alan Chiem MD Topic A21. Ultrasound-Guided Arterial Line Placement ................................................................. .123 Dan Kim MD Topic A22. Gastrostomy/Jejenostomy and Suprapubic Tube Placement .................................. 125 Robert Bramante MD and Christopher Raio MD 2 TOPIC I. FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA SCANNING PROTOCOL Transducer and System Settings The Focused Assessment with Sonography in Trauma or the FAST examination can be performed with a curvilinear or curved array transducer, using either the standard or small footprint curve format. A phased array probe can also be utilized. Pediatric or smaller patients should be imaged with a small curved array or a phased array due to the smaller probe footprint. Ultrasound systems should be set to general abdominal imaging, even if a phased array probe is used. Lower frequency settings or a lower frequency broadband transducer can be used for obese patients. The pulmonary component for evaluation of pneumothorax can be performed with a high frequency linear array probe for greater resolution. However, this portion of the examination can be adequately performed with either the curved or phased array probe that was utilized for the other portions of the examination. Patient Positioning The FAST examination is frequently performed as part of the primary or secondary survey in the evaluation of the trauma patient. It has also been utilized in the assessment of hemodynamically unstable patients with an unknown etiology. Due to the commonly critical nature of these two groups, the FAST examination is generally performed with the patient in the supine position. Image Acquisition The FAST examination differs from some other ultrasound studies since it is a problem focused examination rather than an anatomically derived evaluation. It also includes the evaluation of several potential spaces in additional to abdominal and thoracic organs. There are several anatomic locations that are interrogated for completion of the study. The cardiac views are obtained from the subxiphoid approach in a coronal plane. The abdominal orientation (machine setting) is preferred since the study is performed most commonly in an abdominal preset. The probe can be moved to the patient’s right, lateral to midline, and angled towards the heart to avoid gastric and colonic gas, using the liver as a sonographic window. Alternatively, a parasternal long axis view of the heart can be obtained to avoid abdominal gas. Cardiac evaluation should occur over several cardiac cycles to ensure adequate visualization. The right upper quadrant (RUQ) view is obtained in a coronal plane through the upper right quadrant of the abdomen and the lower right postero-lateral thorax. The probe is initially placed in the mid-axillary line at
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