Ten Things You'll Master Once You've Trained in Clinical Ultrasound

Clinical ultrasound has become an essential part of physical examination, being widely recognized by the medical community as a non-irradiating and non-invasive medical imaging technique. This technique uses sound waves to enable real-time visualization of the body's internal structures, allowing for quick and accurate orientation diagnosis.

Clinical ultrasound training has become a cornerstone to build the practitioner's clinical assessment capabilities. Ultrasound allows you to improve the accuracy of your diagnoses, reduce the number of unnecessary additional tests, and optimize patient care.

In 2022, The Ultrasound Journal published recommendations on the fundamentals of clinical ultrasound that every professional should master at the end of their training. These recommendations cover ten key points, ranging from understanding the physical principles of ultrasound to integrating ultrasound findings into the clinical decision-making process. Here's our recap:

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Know the echo-anatomy of the different parts of the body

Ultrasound offers a more concrete and precise understanding of anatomy, enabling direct and dynamic visualization of the anatomical structures of the human body, as opposed to anatomical models. It also enables us to better understand the spatial relationships between different structures, and to appreciate movements and physiological changes. Regular ultrasound practice helps develop competence in identifying and recognizing normal and abnormal anatomical structures, and in interpreting ultrasound images. This skill is particularly useful in clinical situations where a rapid and accurate assessment of anatomy is necessary for diagnosis and therapeutic decisions. In addition, ultrasound practice promotes a more global approach to anatomy by integrating anatomical knowledge with clinical and physiological knowledge.

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Mastering Image Acquisition

The regular practice of clinical ultrasound allows you to develop familiarity with the different types of probes and the different settings of the ultrasound machine, which will allow you, as you go along, to optimize the quality of the images acquired. Over time, you will develop an in-depth understanding of the fundamentals of ultrasound imaging, such as how sound waves interact with body tissues and how different device settings affect the image produced. By regularly viewing and interpreting ultrasound images, you will develop a strong ability to identify normal and abnormal anatomical structures, as well as an ease in recognizing artifacts and limitations of ultrasound imaging.

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Learn about the FAST exam, the cornerstone of the POCUS in trauma

The Focused Assessment with Sonography for Trauma (FAST) exam is a rapid, targeted ultrasound assessment used to detect the presence of free fluid in the abdominal or peritoneal cavity in trauma patients. This technique was developed to help quickly detect internal bleeding in patients with unstable vital signs after trauma. Using your probe, you can visualize four specific areas of the body: the subxiphoid region, the suprapubic region, the lateral spaces between the liver and the right kidney, and the lateral spaces between the spleen and the left kidney. The goal is to detect the presence of free fluid in these areas, which may indicate internal bleeding. It is important because it can provide quick and valuable information to help guide your patient's care. In particular, the FAST exam can help you identify patients who need urgent surgery to control internal bleeding. It can also help avoid unnecessary interventions in patients who do not have significant internal bleeding.

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Understanding the Indications of Lung Ultrasound

Lung ultrasound, long considered of little use due to the presence of air and sides, is proving invaluable for evaluating various respiratory pathologies, such as pneumothorax, pleural effusion, and infectious lung disease. The pulmonary interface offers crucial information for the management of pleural pathologies, and ultrasound is more suitable than chest X-ray for the diagnosis of pleural effusion in response to pneumonia and the monitoring of pleurisy abundance. Ultrasound is also a more interesting choice than radiography for the diagnosis of residual pneumothorax after drainage or iatrogenic pneumothorax secondary to thoracic procedures. In the case of pneumonia, visible tissue or water structures on the surface of the lung can be detected by ultrasound, which has demonstrated superior sensitivity to X-ray for the detection of pneumonia in the emergency department.

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Assess hemodynamics, heart, and vessels 

Cardiac ultrasound visualizes the moving heart, assesses the size of the heart chambers, the thickness and movement of the walls, and the function of the heart valves. It also provides information on ejection fraction, a key indicator of heart function. Ultrasound is also used to assess vena cava compliance, an indicator of central blood pressure and volume, by measuring the diameter of the inferior vena cava and its changes during the respiratory cycle. In addition, ultrasound can be used to assess the compressibility of veins in the lower extremities, an assessment often used in the diagnosis of deep vein thrombosis (DVT), by detecting whether a vein is completely compressed under the pressure of the ultrasound probe or not.

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Understanding the Limitations of Clinical Ultrasound

Portable ultrasound devices used for clinical ultrasound may have lower image quality than large ultrasound machines, which can make it more difficult to detect certain pathologies. In addition, clinical ultrasound is limited to specific clinical issues and cannot replace more in-depth imaging examinations such as a full ultrasound, CT scan, or MRI. Clinical ultrasound is also limited by the operator's ability to visualize anatomical structures, with some areas of the body being difficult to visualize due to the presence of air, bone, or fatty tissue. In addition, unlike complementary imaging tests, clinical ultrasound can vary greatly depending on the operator and clinical situation. It is therefore important for healthcare professionals to understand these limitations and use clinical ultrasound appropriately, using additional in-depth imaging if necessary.

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Properly disinfect the catheter and follow sterility protocols

Proper disinfection of an ultrasound probe is crucial to prevent the transmission of infections. It is important to follow the specific guidelines of the healthcare facility and equipment manufacturer. After each use, wipe the probe with a soft towel to remove any gel residue, then disinfect it with a disinfectant approved for use with ultrasound probes, such as those based on alcohol, chlorine, or iodine. Follow the manufacturer's instructions regarding the contact time required for effective disinfection. Inspect the probe for damage or wear and store it in a clean, dry place when not in use.

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Integrate ultrasound into your clinical decision-making process

To effectively integrate clinical ultrasound into your management, a thoughtful and systematic approach is required. First, identify clinical situations where ultrasound could provide useful information, such as initial assessment of patients, monitoring the progression of a disease, or guiding procedures. Then, integrate the results of the examination into the patient's overall clinical context, taking into account the history, physical examination, laboratory results, and other imaging tests. Finally, use ultrasound results to inform your clinical decision-making, whether it's to confirm or rule out a diagnosis, decide on treatment, or determine if further investigations are needed.

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Keeping abreast of the latest developments

Clinical ultrasound is an ever-evolving field, with new technologies, techniques, and applications emerging. As a healthcare professional, it is important to stay informed of these advances to offer the best care to your patients. Regularly participate in courses, workshops or conferences on clinical ultrasound, regularly read articles from scientific journals. We also advise you to join learned societies in the field of clinical ultrasound. These organizations often offer educational resources, networking opportunities, and regular updates on the latest advancements in the field.

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Develop a focused area of practice

By focusing on a specific area of clinical ultrasound, you can develop in-depth expertise and improve your skills in that area. This can lead to more accurate diagnoses and more effective management of your patients. By being able to perform and interpret ultrasound exams in a specific area, you can also reduce the need to unnecessarily refer your patients to other specialists, which can improve continuity of care. Developing a key area of practice in clinical ultrasound can also open up research and teaching opportunities for you. You will be able to contribute to the advancement of the field by conducting research, teaching other healthcare professionals, or publishing articles in medical journals.

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Conclusion

In conclusion, clinical ultrasound training offers many benefits for healthcare professionals. It allows you to control the echo-anatomy, the acquisition of images, the FAST examination in traumatology, the indications of the pulmonary ultrasound, the evaluation of the hemodynamics, the heart and the vessels, as well as the correct disinfection of the probe and the adherence to sterility protocols. In addition, understanding the limitations of clinical ultrasound and integrating this technique into the clinical decision-making process is essential for effective and safe use. Finally, the development of a focused area of practice and participation in continuing education activities allows you to stay informed of the latest advances in this ever-changing field.

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_{To read more: Hoppmann, Richard A., et al. "International consensus conference recommendations on ultrasound education for undergraduate medical students." The Ultrasound Journal 14.1 (2022): 31.}