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Re: [echocardiography] Top ten list of things new echosonographers should know (but probably don't)

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  • Elton
    Your first year will be your most important in terms of learning how to scan, and what to scan. Your brain is still trying to figure it all out. First of all,
    Message 1 of 15 , Nov 26, 2003
      Your first year will be your most important in terms of learning how to
      scan, and what to scan. Your brain is still trying to figure it all
      out. First of all, it doesn't know what it looks like when the heart is
      normal. If it doesn't know what is normal, how will it know when it's
      abnormal? (For those in doubt, I challenge you to try this example...
      invert the image upside-down on the screen. Doesn't it feel awkward and
      uncomfortable to see the echo in this way?) Furthermore, in that first
      year you are teaching yourself how to create a scan of an object that
      you can't see. You are learning how to create the standard views and
      making it "diagnostic". You learn how to pull out a tough regurgitant
      jet, or obtain the true peak velocity. This all takes practice and
      takes development of your eye-hand coordination.

      1. During your clinical training/internship, fight to get transducer
      time. No one is born with the talent to scan; sonography is a skill
      that is gained by practice. Be sure to practice, on every patient, all
      of the views, including: subcostal, suprasternal notch, right
      parasternal views, and the pedof probe. I still perform all of these
      views because it helps me to stay practiced. My theory is simple: If I
      don't use the skill, I lose it. Then, when it comes time to use it,
      I'll have the confidence to employ the skill.

      Employers want to hire sonographers who are competent, and confident!
      Confidence comes from experience. So, practice, practice, PRACTICE!

      2. When seeking your first sonography job, find a lab that will help
      you to grow. Find a large lab with several sonographers who can help
      guide you; seek out their help. The lab should also be involved in all
      aspects of echocardiography; gain experience with all of it including,
      intra-op echo, TEE, stress echo, dobutamine stress echo, and
      pediatrics. I would also recommend learning the other aspects of
      cardiology and cardiovascular surgery. Be well rounded.

      Refrain from joining labs where you are left to yourself to scan, such
      as mobile services or small physicians offices. It's a very critical
      time in your career. You will be better off in an environment where you
      can bounce concepts and principles off the experienced techs, or just
      to get some help scanning when you need it.

      3. If your desire is to be an excellent sonographer, work in a lab
      where you are required to write out preliminary reports. When you can
      comment on what you just saw and come up with an interpretation, you
      will be a much better sonographer than one who just scans. This can be
      a little intimidating because the pressure is on you to make the
      correct interpretation. But, that's okay... you learn how to interpret
      real quick!

      4. Force yourself to play video games! This especially helps in
      developing your stress echo skills. Simply put, we are professional
      video gamers... are we not? The same eye-hand coordination skills are
      required in sonography, and especially with stress echoes. Performing
      stress echoes is the hardest skill to perform in all of the sonography
      disciplines. Our job as cardiac sonographers is to obtain diagnostic
      wall motion analysis on four cardiac views, on a panting patient who
      has just come off a maximal stress test, all within 60 seconds! (We all
      know who the stress is really on...YOU!) You can develop the fast
      twitch muscles and fine motor skills by playing video games. I'm not
      talking about playing your computers solitaire card game or online
      poker, here. The action games or simulators work best; the faster the
      game, the better.


      John, I hope this helps!

      Elton
      14 years


      ------------------------------------------------------------------------
      !

      Elton Aguilar, BS RDCS
      T2 Imaging, Inc.
      The Ultimate in Extreme Echocardiography

      eltonaa@...




      On Sunday, November 23, 2003, at 05:56 AM, johnhollisusa wrote:

      > I am compiling a list of things that new echosonographers should know
      > but probably don't. I am an echo student and will use your input in
      > my senior presentation. I will also compare the input I get to see
      > how well these items are addressed in the ASE's Guidelines for Cardiac
      > Sonographer Education.
      >
      > Please include how many years of scanning experience you have.
      >
      > Thank you for your help.
    • Elizabeth Maher
      Ed Chait wrote: Dear Ed I agree it is confusing but the following has helped me in the past. In the normal aortic valve the Doppler profile is one of early
      Message 2 of 15 , Nov 27, 2003
        Ed Chait wrote:
        Dear Ed
        I agree it is confusing but the following has helped me in the past.
        In the normal aortic valve the Doppler profile is one of early peaking
        and shorter duration than that of the mitral regurgitant signal.
        An early descent of the Doppler signal can be seen in extreme cases of
        severe mitral regurgitation where there is a rapid rise in atrial
        pressure and conversely the Aortic Doppler profile can also peak later
        in severe aortic stenosis.
        The appearanceie mobility and thickening of the aortic leaflets should
        give some clue to the presence of aortic stenosis
        Look for left ventricular hypertrophy which suggests but does not prove
        stenosis.
        The Continuity equation would give an estimate of the AVA and that
        should be consistent with the patient's sysmptoms and the visual
        estimation of valve excursion although there is the occasional symptom
        free patient with critical aortic stenosis.
        Severely reduced LV function can result in the incomplete opening of a
        non stenotic valve. This situation can be unmasked with Dobutamine.

        Liz Maher


        >I have 23 years of scanning experience.
        >
        >My contribution has to be one mistake that is commonly made by new
        >echosonographers and which can have serious consequences.
        >
        >It is distinguishing between MR and AS jets, which can seem very similar to
        >inexperienced techs.
        >
        >I shudder to think how many cases of severe AS have been reported as a
        >result of the echo tech recording an MR jet with a Pedoff probe.
        >
        >Ed Chait
        >
        >
        >
        >
        >
        >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
        >
        >
        >
        >
        >
        >
      • Lizz
        I d like to add: Please have a good posture and comfortable chair. I ve seen alot of back and shoulder problems develope in techs who had been doing scans for
        Message 3 of 15 , Nov 28, 2003
          I'd like to add: Please have a good posture and comfortable chair.  I've seen alot of back and shoulder problems develope in techs who had been doing scans for less than 6 months because they either worked right handed and leaned over patients, or they failed to maintain good posture. 
           
          Lizz

          johnhollisusa <jhollis48@...> wrote:
          I am compiling a list of things that new echosonographers should know
          but probably don't. I am an echo student and will use your input in
          my senior presentation. I will also compare the input I get to see
          how well these items are addressed in the ASE's Guidelines for Cardiac
          Sonographer Education.

          Please include how many years of scanning experience you have.

          Thank you for your help.




          Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/




          Do you Yahoo!?
          Free Pop-Up Blocker - Get it now

        • Kemil Pilotte
          A detailed knowledg of cardiac anatomy and the equivalent 2D image When an imaging plane is right and when it is wrong and what are the standards for the right
          Message 4 of 15 , Nov 30, 2003
            A detailed knowledg of cardiac anatomy and the equivalent 2D image
            When an imaging plane is right and when it is wrong and what are the
            standards for the right planes
            What all those instrument numbers that appear on their instruments mean and
            how they affect the quality of imaging
            A thorough knowledge of the "standards"

            Have 15 yrs of experience

            ----- Original Message -----
            From: "johnhollisusa" <jhollis48@...>
            To: <echocardiography@yahoogroups.com>
            Sent: Sunday, November 23, 2003 7:56 AM
            Subject: [echocardiography] Top ten list of things new echosonographers
            should know (but probably don't)


            > I am compiling a list of things that new echosonographers should know
            > but probably don't. I am an echo student and will use your input in
            > my senior presentation. I will also compare the input I get to see
            > how well these items are addressed in the ASE's Guidelines for Cardiac
            > Sonographer Education.
            >
            > Please include how many years of scanning experience you have.
            >
            > Thank you for your help.
            >
            >
            >
            >
            > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
            >
            >
            >
          • Lu Rutherford
            Hello... I have 30+yrs of echo experience and had a school for awhile. I agree here... and it all can come under 2 headings: 1. Knobology = all and
            Message 5 of 15 , Dec 1, 2003
              Hello... I have 30+yrs of echo experience and had a "school" for awhile.
              I agree here... and it all can come under 2 headings:
               
              1. Knobology = all and everything to do with the knobs on the equipment, the calculations behind them and how they are derived. Plus, how to properly pre-set them to give you what you need. (Doppler/2-D/M-Mode measurements and formulas)
               
              2. Probe Orientation = all and everything to do with the probe. From the transducer and the physics behind how it produces the sound and receives it, to correct angulation, and how that enhances your image. (Anatomy/Soundwave Physics/"Geometrics")
               
              Good Luck!

              Kemil Pilotte <kpilotte@...> wrote:
              A detailed knowledg of cardiac anatomy and the equivalent 2D image
              When an imaging plane is right and when it is wrong and what are the
              standards for the right planes
              What all those instrument numbers that appear on their instruments mean and
              how they affect the quality of imaging
              A thorough knowledge of the "standards"

              Have 15 yrs of experience

              ----- Original Message -----
              From: "johnhollisusa"
              To:
              Sent: Sunday, November 23, 2003 7:56 AM
              Subject: [echocardiography] Top ten list of things new echosonographers
              should know (but probably don't)


              > I am compiling a list of things that new echosonographers should know
              > but probably don't. I am an echo student and will use your input in
              > my senior presentation. I will also compare the input I get to see
              > how well these items are addressed in the ASE's Guidelines for Cardiac
              > Sonographer Education.
              >
              > Please include how many years of scanning experience you have.
              >
              > Thank you for your help.
              >
              >
              >
              >
              > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
              >
              >
              >





              Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/


              Do you Yahoo!?
              Free Pop-Up Blocker - Get it now

            • Ed Chait
              I ll add another one. New sonographers (and old ones for that matter) should invest enough time and effort into finding the best acoustic window before
              Message 6 of 15 , Dec 1, 2003
                I'll add another one.

                New sonographers (and old ones for that matter) should invest enough time
                and effort into finding the best acoustic window before committing to one.

                I remember that quite often I would have to repeat all my scanning, as I
                would finish my views and then slide into a better window.

                Ed Chait, RDCS (too many years, not enough days)
              • info@msl4u.com
                More years of expeience than I care to share! The most useful advice I feel that I give my students is to know your patient and patient history, including ECG,
                Message 7 of 15 , Dec 1, 2003
                  More years of expeience than I care to share! The most useful advice I feel
                  that I give my students is to know your patient and patient history,
                  including ECG, CXR blood workup-CKMB,SGOT,LDH, history and complaints. With
                  these in mind when you bring a study for review does it look like, smell
                  like and taste like (whatever anomally you find) if it doesn't go back til
                  it does! I have enjoyed the respones so far and agree with all of them.



                  --
                  Kevin G. Scott
                  CEO Medical Software Ltd.
                • Tony Forshaw
                  Relax. How many of us had very sore necks and shoulders from gripping onto the transducer too tightly. The probe won t escape, just relax and be comfortable.
                  Message 8 of 15 , Dec 1, 2003
                    Relax. How many of us had very sore necks and shoulders from gripping onto
                    the transducer too tightly. The probe won't escape, just relax and be
                    comfortable.

                    Tony Forshaw
                    ----- Original Message -----
                    From: "Ed Chait" <edchait4@...>
                    To: <echocardiography@yahoogroups.com>
                    Sent: Tuesday, December 02, 2003 6:18 AM
                    Subject: Re: [echocardiography] Top ten list of things new echosonographers
                    should know (but probably don't)


                    >
                    > I'll add another one.
                    >
                    > New sonographers (and old ones for that matter) should invest enough time
                    > and effort into finding the best acoustic window before committing to one.
                    >
                    > I remember that quite often I would have to repeat all my scanning, as I
                    > would finish my views and then slide into a better window.
                    >
                    > Ed Chait, RDCS (too many years, not enough days)
                    >
                    >
                    >
                    >
                    >
                    > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                    >
                    >
                    >
                  • Gerald Hinderliter
                    Just getting back from a week of.f I am reading this a bit late. But enjoying the response. I would only add that our career is a progressing science and so
                    Message 9 of 15 , Dec 2, 2003
                      Just getting back from a week of.f I am reading this a bit late. But enjoying the response. I would only add that our career is a progressing science and so those items that were good yesterday maybe obsilete 2-5 years down the road.
                      I have been doing Echo over a decade and seen much change and I do not think it will stop. There is always R&D and studies going on, so change is our only constant. Good holidays all. JD

                      >>> jhollis48@... 11/23/03 06:56AM >>>
                      I am compiling a list of things that new echosonographers should know
                      but probably don't. I am an echo student and will use your input in
                      my senior presentation. I will also compare the input I get to see
                      how well these items are addressed in the ASE's Guidelines for Cardiac
                      Sonographer Education.

                      Please include how many years of scanning experience you have.

                      Thank you for your help.




                      Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                    • Gerald Hinderliter
                      This is good Chris. I had a sudent confused. He knew by 2-d there was much AV sclerosis and must be stenotic, yet there was a MR jet hugging the IAS. The
                      Message 10 of 15 , Dec 2, 2003
                        This is good Chris. I had a sudent confused. He knew by 2-d there was much AV sclerosis and must be stenotic, yet there was a MR jet hugging the IAS. The velcoties were close. I feel this is a down side of digital acquisition w/o sound.
                        The only was I knew I had the forward flow velocity of the AV and not the MR was the distinctive sand paper sound.
                        Good Holiday all. JD

                        >>> Chris.Brown@... 12/02/03 01:36AM >>>
                        With Aortic Stenosis and Mitral Regurg - You would have to be with me to
                        demonstrate but I have found that the signals sound different and have used
                        that to aid in avoiding confusion.
                        [or maybe I have been working on my own for too long ;-)]

                        Chris Brown
                        Shetland
                        UK



                        -----Original Message-----
                        From: Elizabeth Maher [mailto:lizzymaher@...]
                        Sent: 27 November 2003 22:18
                        To: echocardiography@yahoogroups.com
                        Subject: Re: [echocardiography] Top ten list of things new
                        echosonographers should know (but probably don't)


                        Ed Chait wrote:
                        Dear Ed
                        I agree it is confusing but the following has helped me in the past.
                        In the normal aortic valve the Doppler profile is one of early peaking
                        and shorter duration than that of the mitral regurgitant signal.
                        An early descent of the Doppler signal can be seen in extreme cases of
                        severe mitral regurgitation where there is a rapid rise in atrial
                        pressure and conversely the Aortic Doppler profile can also peak later
                        in severe aortic stenosis.
                        The appearanceie mobility and thickening of the aortic leaflets should
                        give some clue to the presence of aortic stenosis
                        Look for left ventricular hypertrophy which suggests but does not prove
                        stenosis.
                        The Continuity equation would give an estimate of the AVA and that
                        should be consistent with the patient's sysmptoms and the visual
                        estimation of valve excursion although there is the occasional symptom
                        free patient with critical aortic stenosis.
                        Severely reduced LV function can result in the incomplete opening of a
                        non stenotic valve. This situation can be unmasked with Dobutamine.

                        Liz Maher


                        >I have 23 years of scanning experience.
                        >
                        >My contribution has to be one mistake that is commonly made by new
                        >echosonographers and which can have serious consequences.
                        >
                        >It is distinguishing between MR and AS jets, which can seem very similar to
                        >inexperienced techs.
                        >
                        >I shudder to think how many cases of severe AS have been reported as a
                        >result of the echo tech recording an MR jet with a Pedoff probe.
                        >
                        >Ed Chait
                        >
                        >
                        >
                        >
                        >
                        >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                        >
                        >
                        >
                        >
                        >
                        >






                        Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/




                        Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                      • Ed Chait
                        ... From: Brown, Chris To: Sent: Tuesday, December 02, 2003 12:36 AM Subject: RE:
                        Message 11 of 15 , Dec 2, 2003
                          ----- Original Message -----
                          From: "Brown, Chris" <Chris.Brown@...>
                          To: <echocardiography@yahoogroups.com>
                          Sent: Tuesday, December 02, 2003 12:36 AM
                          Subject: RE: [echocardiography] Top ten list of things new echosonographers
                          should know (but probably don't)


                          > With Aortic Stenosis and Mitral Regurg - You would have to be with me to
                          > demonstrate but I have found that the signals sound different and have
                          used
                          > that to aid in avoiding confusion.
                          > [or maybe I have been working on my own for too long ;-)]
                          >
                          > Chris Brown
                          > Shetland
                          > UK


                          Oh, I agree Chris. It's a mistake only neophyte sonographers make, but it's
                          a common one when you are first starting out.

                          Ed Chait, RDCS
                        • timothy_eller
                          MR should be of a longer duration than AS. MR begins before aortic outflow because during IVCT the LV pressure is greater than LA pressure but less than aortic
                          Message 12 of 15 , Dec 2, 2003
                            MR should be of a longer duration than AS.

                            MR begins before aortic outflow because during IVCT the LV pressure
                            is greater than LA pressure but less than aortic (aorta) pressure.
                            The aortic valve closes before MV opening and you can still have MR
                            during IVRT, again because LV pressure is greater than LA pressure.

                            If you use calipers and the ECG as a reference point. You can put
                            one caliper at the beginning of the R wave and the other at the
                            beginning of the AS/MR signal. If you have both signals, the time
                            measured should be shorter for MR. You can also measure the absolute
                            durations of both signals. AS will be of shorter duration.

                            I take a real good look at the valve in every view, especially the
                            short axis. In our lab we routinely planimeter the AV. I know about
                            all the pitfalls in AV planimetry (calcification/shadowing etc) but
                            there are also pitfalls in the Doppler/Continuity derived AVA (not
                            parallel to jet, incorrect LVOT diameter etc). We find that if you
                            make the effort to planimeter the valve it makes you really focus on
                            the valve and get a feel for the severity.

                            Hope that makes sense
                            Tim


                            --- In echocardiography@yahoogroups.com, "Gerald Hinderliter"
                            <Gerald.Hinderliter@h...> wrote:
                            > This is good Chris. I had a sudent confused. He knew by 2-d there
                            was much AV sclerosis and must be stenotic, yet there was a MR jet
                            hugging the IAS. The velcoties were close. I feel this is a down side
                            of digital acquisition w/o sound.
                            > The only was I knew I had the forward flow velocity of the AV and
                            not the MR was the distinctive sand paper sound.
                            > Good Holiday all. JD
                            >
                            > >>> Chris.Brown@S... 12/02/03 01:36AM >>>
                            > With Aortic Stenosis and Mitral Regurg - You would have to be with
                            me to
                            > demonstrate but I have found that the signals sound different and
                            have used
                            > that to aid in avoiding confusion.
                            > [or maybe I have been working on my own for too long ;-)]
                            >
                            > Chris Brown
                            > Shetland
                            > UK
                            >
                            >
                            >
                            > -----Original Message-----
                            > From: Elizabeth Maher [mailto:lizzymaher@c...]
                            > Sent: 27 November 2003 22:18
                            > To: echocardiography@yahoogroups.com
                            > Subject: Re: [echocardiography] Top ten list of things new
                            > echosonographers should know (but probably don't)
                            >
                            >
                            > Ed Chait wrote:
                            > Dear Ed
                            > I agree it is confusing but the following has helped me in the
                            past.
                            > In the normal aortic valve the Doppler profile is one of early
                            peaking
                            > and shorter duration than that of the mitral regurgitant signal.
                            > An early descent of the Doppler signal can be seen in extreme cases
                            of
                            > severe mitral regurgitation where there is a rapid rise in atrial
                            > pressure and conversely the Aortic Doppler profile can also peak
                            later
                            > in severe aortic stenosis.
                            > The appearanceie mobility and thickening of the aortic leaflets
                            should
                            > give some clue to the presence of aortic stenosis
                            > Look for left ventricular hypertrophy which suggests but does not
                            prove
                            > stenosis.
                            > The Continuity equation would give an estimate of the AVA and that
                            > should be consistent with the patient's sysmptoms and the visual
                            > estimation of valve excursion although there is the occasional
                            symptom
                            > free patient with critical aortic stenosis.
                            > Severely reduced LV function can result in the incomplete opening
                            of a
                            > non stenotic valve. This situation can be unmasked with Dobutamine.
                            >
                            > Liz Maher
                            >
                            >
                            > >I have 23 years of scanning experience.
                            > >
                            > >My contribution has to be one mistake that is commonly made by new
                            > >echosonographers and which can have serious consequences.
                            > >
                            > >It is distinguishing between MR and AS jets, which can seem very
                            similar to
                            > >inexperienced techs.
                            > >
                            > >I shudder to think how many cases of severe AS have been reported
                            as a
                            > >result of the echo tech recording an MR jet with a Pedoff probe.
                            > >
                            > >Ed Chait
                            > >
                            > >
                            > >
                            > >
                            > >
                            > >Your use of Yahoo! Groups is subject to
                            http://docs.yahoo.com/info/terms/
                            > >
                            > >
                            > >
                            > >
                            > >
                            > >
                            >
                            >
                            >
                            >
                            >
                            >
                            > Your use of Yahoo! Groups is subject to
                            http://docs.yahoo.com/info/terms/
                            >
                            >
                            >
                            >
                            > Your use of Yahoo! Groups is subject to
                            http://docs.yahoo.com/info/terms/
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