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Ultrasound practitioners as physician extenders in the busy ultrasound department: our first-year experience
S18
Ultrasound in Medicine and Biology
populated locations, as well as within military medical units, research expeditions, or mass-casualty areas. Methods: A space-adapted version of the HDI-5000 system (ATL/ Philips, USA) has been deployed by NASA aboard the International Space Station (ISS) as a research tool. The care providers on orbit usually have no medical background and minimal medical and hardware training. To take advantage of the system for clinical imaging, real-time video downlink and bi-directional voice are used to remotely guide the astronauts to capture clinically useful imaging data for evaluation on the ground. Results: A system of remote guidance was developed, and guided sonography performed on groups of healthy volunteer subjects on the ground, in parabolic flight, and aboard the ISS, with self-scanning having been the main mode in the latter setting. Standardized terrestrial protocols were minimally modified for microgravity and pursued, including the expanded FAST (Focused Assessment by Sonography in Trauma) examination with hemo- and pneumothorax screening, general abdominal survey, and duplex carotid examination, among others. Time required for each application, quality of the transmission and that of study content, and other parameters were studied. The techniques developed for ISS application include training of the guidance experts and the future on-site operators, the use of communications, guidance terminology, reference tools, and other aspects of remotely guided sonography. Conclusions: Focused sonographic tasks can be performed by minimally trained personnel in medical emergencies, given appropriate communications and real-time expert support during acquisition. 32617 Ultrasound practitioners as physician extenders in the busy ultrasound department: Our first-year experience Bude RO,* Fatchett JP, Hayes TA, Radiology, University of Michigan, Ann Arbor, MI Objective: Our ultrasound case load became too burdensome for our radiologists to manage. We trained 2 experienced sonographers as physician assistants (ultrasound practitioners or U.P.) to triage and preliminarily dictate cases. This increased our productivity and allowed us to manage our workload with existing staff. Our first-year results are reported. Methods: Two U.P. were trained to triage and provisionally dictate ultrasound cases. After training, one U.P. per day autonomously monitored hourly cases from 3 to 4 offsite technologists via a PACS system, requesting additional images and video clips as needed to insure a complete examination. A radiologist was available for consultation as needed. The U.P. dictated provisional reports using voice-recognition equipment. At day’s end, a radiologist reviewed all cases and reports with the U.P and formally signed the reports. From program inception, each dictated report was graded by the radiologist using a four-category grading system: category A (completely acceptable), B (minor change required, not affecting patient care), C (moderate change required, affecting patient care), and D (major change required, substantially affecting patient care). Percentage of each category of report was calculated for each U.P. in 4-week intervals and for the overall duration of the study. A record was also kept of the number of patient call-backs required to insure technically satisfactory examinations. Results: For the study duration of 36 weeks, the mean number of patient examinations triaged per day was 19.2 (3396 patients/177 days). 94.7% of dictated reports were category A (completely acceptable) (3215/3396); 4.9% of reports were category B (168/3396); 0.4% of reports were category C (13/3396); 0.0% of reports were category D (0/3396). Only one patient call-back (1/3396) was required to satisfactorily complete a study. Approximately 1–1.5 hours were required for the radiologist to read the examinations and formally sign the reports.
Volume 29, Number 5S, 2003 Conclusions: The program exceeded expectations as the vast majority of dictated reports were completely acceptable, with a negligible incidence of patient call-backs. The U.P. allowed us to increase radiologist productivity in a manageable way. 32108 The EMIT structured training programme in medical ultrasound Aitken V,* Consortium E, Medical Engineering and Physics, King’s College, London, United Kingdom Objective: The European Medical Imaging Technology (EMIT) training project has a remit to develop and deliver a hospital-based work-linked training programme for medical physics graduates in ultrasound. It is intended that the training pack should also be a useful life-long training resource for other healthcare professionals working in ultrasound. Methods: The project Consortium comprises Universities and Hospitals from the UK, Sweden, France, and Italy, with the European Federation of Medical Physics working together under the Leonardo EU program. The material is Internet and CD based using e-Workbooks and image databases (IDB). The module encompasses the physics, instrumentation, and practical applications found in current clinical practice. The training programme consists of a 4-month training timetable; a workbook with training tasks, leading to specific competencies; an IDB and course guide. The project has also developed a Digital Dictionary of terms. Results: The module consists of 44 tasks aimed at developing specified competencies. The tasks are designed to be used by trainees from diverse backgrounds and under different levels of supervision. The task descriptions are therefore required to be highly prescriptive. However, a supervisor may need to modify the tasks according to local protocols. In this case, the Supervisor uses the EMIT tasks as a “good practice guide” upon which to make local amendments. All tasks have a similar structure: Aim & Competencies; Equipment & Materials; Procedures & Measurements; Observations & Interpretations; Conclusions & References. To demonstrate competency, the trainee must describe the tasks undertaken, discuss the results, and derive conclusions, to the satisfaction of the supervisor. A task is only completed when verified by the supervisor. Conclusions: The EMIT structured programme provides a framework in which trainees can learn a set of competencies that are relevant for their professional needs. In addition, it can be used to teach ultrasound theory and practice to clinical users in a structured and interactive way. There will be a conference to disseminate and evaluate the EMIT training programme in Trieste, Italy, 9 –12th October, 2003 (URL: http://www.emerald2.net). 32555 WFUMB training for the trainers ultrasound workshop in Dhaka Vairojanavong K, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand Objective: The objectives are: 1) to train trainees to become trainers in the field of medical ultrasound in Bangladesh, a developing country with a population of over 120 millions; 2) to encourage trainers to organize an ultrasound workshop and hands-on training course in their regional institutes; and 3) to assess cost– benefit in organising the workshop Methods: A 3-day ultrasound workshop between June 6 – 8, 2002, was organised in the Auditorium of the Bangladesh Society of Ultrasonograpgy (BSU) in Dhaka. Five honorary lecturers presented lectures and also provided hands-on training. A handbook and two donated textbooks were given to each participant. Results: There were 37 participants, 14 from the Dhaka area; many of them were teachers and/or administrative councilors of BSU, 11 from
Ultrasound in Medicine and Biology
populated locations, as well as within military medical units, research expeditions, or mass-casualty areas. Methods: A space-adapted version of the HDI-5000 system (ATL/ Philips, USA) has been deployed by NASA aboard the International Space Station (ISS) as a research tool. The care providers on orbit usually have no medical background and minimal medical and hardware training. To take advantage of the system for clinical imaging, real-time video downlink and bi-directional voice are used to remotely guide the astronauts to capture clinically useful imaging data for evaluation on the ground. Results: A system of remote guidance was developed, and guided sonography performed on groups of healthy volunteer subjects on the ground, in parabolic flight, and aboard the ISS, with self-scanning having been the main mode in the latter setting. Standardized terrestrial protocols were minimally modified for microgravity and pursued, including the expanded FAST (Focused Assessment by Sonography in Trauma) examination with hemo- and pneumothorax screening, general abdominal survey, and duplex carotid examination, among others. Time required for each application, quality of the transmission and that of study content, and other parameters were studied. The techniques developed for ISS application include training of the guidance experts and the future on-site operators, the use of communications, guidance terminology, reference tools, and other aspects of remotely guided sonography. Conclusions: Focused sonographic tasks can be performed by minimally trained personnel in medical emergencies, given appropriate communications and real-time expert support during acquisition. 32617 Ultrasound practitioners as physician extenders in the busy ultrasound department: Our first-year experience Bude RO,* Fatchett JP, Hayes TA, Radiology, University of Michigan, Ann Arbor, MI Objective: Our ultrasound case load became too burdensome for our radiologists to manage. We trained 2 experienced sonographers as physician assistants (ultrasound practitioners or U.P.) to triage and preliminarily dictate cases. This increased our productivity and allowed us to manage our workload with existing staff. Our first-year results are reported. Methods: Two U.P. were trained to triage and provisionally dictate ultrasound cases. After training, one U.P. per day autonomously monitored hourly cases from 3 to 4 offsite technologists via a PACS system, requesting additional images and video clips as needed to insure a complete examination. A radiologist was available for consultation as needed. The U.P. dictated provisional reports using voice-recognition equipment. At day’s end, a radiologist reviewed all cases and reports with the U.P and formally signed the reports. From program inception, each dictated report was graded by the radiologist using a four-category grading system: category A (completely acceptable), B (minor change required, not affecting patient care), C (moderate change required, affecting patient care), and D (major change required, substantially affecting patient care). Percentage of each category of report was calculated for each U.P. in 4-week intervals and for the overall duration of the study. A record was also kept of the number of patient call-backs required to insure technically satisfactory examinations. Results: For the study duration of 36 weeks, the mean number of patient examinations triaged per day was 19.2 (3396 patients/177 days). 94.7% of dictated reports were category A (completely acceptable) (3215/3396); 4.9% of reports were category B (168/3396); 0.4% of reports were category C (13/3396); 0.0% of reports were category D (0/3396). Only one patient call-back (1/3396) was required to satisfactorily complete a study. Approximately 1–1.5 hours were required for the radiologist to read the examinations and formally sign the reports.
Volume 29, Number 5S, 2003 Conclusions: The program exceeded expectations as the vast majority of dictated reports were completely acceptable, with a negligible incidence of patient call-backs. The U.P. allowed us to increase radiologist productivity in a manageable way. 32108 The EMIT structured training programme in medical ultrasound Aitken V,* Consortium E, Medical Engineering and Physics, King’s College, London, United Kingdom Objective: The European Medical Imaging Technology (EMIT) training project has a remit to develop and deliver a hospital-based work-linked training programme for medical physics graduates in ultrasound. It is intended that the training pack should also be a useful life-long training resource for other healthcare professionals working in ultrasound. Methods: The project Consortium comprises Universities and Hospitals from the UK, Sweden, France, and Italy, with the European Federation of Medical Physics working together under the Leonardo EU program. The material is Internet and CD based using e-Workbooks and image databases (IDB). The module encompasses the physics, instrumentation, and practical applications found in current clinical practice. The training programme consists of a 4-month training timetable; a workbook with training tasks, leading to specific competencies; an IDB and course guide. The project has also developed a Digital Dictionary of terms. Results: The module consists of 44 tasks aimed at developing specified competencies. The tasks are designed to be used by trainees from diverse backgrounds and under different levels of supervision. The task descriptions are therefore required to be highly prescriptive. However, a supervisor may need to modify the tasks according to local protocols. In this case, the Supervisor uses the EMIT tasks as a “good practice guide” upon which to make local amendments. All tasks have a similar structure: Aim & Competencies; Equipment & Materials; Procedures & Measurements; Observations & Interpretations; Conclusions & References. To demonstrate competency, the trainee must describe the tasks undertaken, discuss the results, and derive conclusions, to the satisfaction of the supervisor. A task is only completed when verified by the supervisor. Conclusions: The EMIT structured programme provides a framework in which trainees can learn a set of competencies that are relevant for their professional needs. In addition, it can be used to teach ultrasound theory and practice to clinical users in a structured and interactive way. There will be a conference to disseminate and evaluate the EMIT training programme in Trieste, Italy, 9 –12th October, 2003 (URL: http://www.emerald2.net). 32555 WFUMB training for the trainers ultrasound workshop in Dhaka Vairojanavong K, Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand Objective: The objectives are: 1) to train trainees to become trainers in the field of medical ultrasound in Bangladesh, a developing country with a population of over 120 millions; 2) to encourage trainers to organize an ultrasound workshop and hands-on training course in their regional institutes; and 3) to assess cost– benefit in organising the workshop Methods: A 3-day ultrasound workshop between June 6 – 8, 2002, was organised in the Auditorium of the Bangladesh Society of Ultrasonograpgy (BSU) in Dhaka. Five honorary lecturers presented lectures and also provided hands-on training. A handbook and two donated textbooks were given to each participant. Results: There were 37 participants, 14 from the Dhaka area; many of them were teachers and/or administrative councilors of BSU, 11 from