Two Job Openings

Daris Reed has an opening at Tséhootsooí Medical Center (FDIHB, Inc.). contact information is:

Daris Reed R.T (R) (ARRT)

Radiology Supervisor

Tséhootsooí Medical Center (FDIHB, Inc.)

Corner of Routes N7 & N12

P.O. Box 649

Fort Defiance, AZ 86504

Phone: (928)729-8426

Fax: (928)729-8358

Daris.Reed@fdihb.org

Also,

Amy Plummer is looking for someone at John C. Lincoln, North Mountain.

You can reach Amy at

Amy.plummer@JCL.com or contact their website to apply.

AIUM Statement on Measurement of Fetal Heart Rate

Background: 

Besides watching the monitor and actually counting heartbeats, there are two sonographic methods of measuring the fetal heart rate: M-mode and spectral Doppler.* The measurement of the rate, both in M-mode and spectral Doppler, is performed by placing a pair of cursors to span a known number of heartbeats on the tracing. At a fetal size (crown-rump length) of 2 mm to 1 cm (approximately 5+ to 7 weeks), the heartbeat can be visualized by B-mode and then "heard" by spectral Doppler ultrasound. 

 *Handheld Doppler instruments without imaging capability are not the topic of this statement.

Statement on Measurement of the Fetal Heart Rate

When attempting to obtain fetal heart rate with a diagnostic ultrasound system, the AIUM recommends using M-mode at first because the time-averaged acoustic intensity delivered to the fetus is lower with M-mode than with spectral Doppler. If this is unsuccessful, spectral Doppler ultrasound may be used with the following guidelines: use spectral Doppler only briefly (eg, 4-5 heart beats), and keep the thermal index (TIS for soft tissues in the first trimester and TIB for bones in second and third trimesters) as low as possible, preferably below 1 in accordance with the ALARA (as low as reasonably achievable) principle. 

The AIUM and AUA published guidelines on use of ultrasound in urology. This opens the door for sonographers to work directly with urology patients while having an appropriately trained urologist interpret the images. more information can be found at http://www.aium.org/publications/viewStatement.aspx?id=44

What is an Accredited Program

CAAHEP vs. Non-CAAHEP Program Accreditation Podcast

Many applicants to the program ask what is the advantage to graduating from an accredited program. The link above explains how the ARDMS differentiates between programs.

FDA moving closer to approving contrast for sonographic studies

This week we moved a major step closer to utilizing contrast in routine sonographic imaging:

http://www.businesswire.com/news/home/20111027006987/en/ICUS-Applauds-FDA-Modification-Boxed-Warnings-Ultrasound

ICUS Applauds FDA Modification of Boxed Warnings on Certain Ultrasound Contrast Agents; Cite Patient

www.businesswire.com

ICUS Applauds FDA decision to modify DEFINITY product labels. The FDA's decision should lead to better imaging studies, better diagnosis for patients

British Baby Business

http://www.shieldsgazette.com/news/business/latest-news/unborn_babies_can_be_tv_stars_1_3837250

Dancing with the future stars!

Unborn babies can be TV stars - Latest News - Shields Gazette

www.shieldsgazette.com

Ultrasound Awareness Month

From the ARDMS:

Ultrasound Awareness Month

October is Medical Ultrasound Awareness Month

ARDMS is celebrating Medical Ultrasound Awareness Month in October.  This month and throughout the year, ARDMS encourages Registrants and ultrasound professionals to raise medical ultrasound awareness.

With ultrasound’s increasing role in medicine, one of the main goals of Medical Ultrasound Awareness Month is to provide the public with a better understanding of ultrasound and its many uses in health care. 

Here are some ways to educate the public, raise medical ultrasound awareness, and celebrate your profession during Medical Ultrasound Awareness Month: 

1. Tell your patients you are certified: The mission of ARDMS is “quality care and patient safety through the certification and continuing competency of ultrasound professionals.”  Share with patients that you are certified by ARDMS, that you had to pass a series of rigorous examinations to earn the certification, and that as a result, your patients are receiving the highest level of care. To assist you in sharing information with your patients, use the ARDMS brochure entitled, “Understanding Sonography...and the Importance of a Certified Sonographer.”  If you are interested in receiving this brochure, send an e-mail to communications@ardms.org and we will add your name to distribution efforts.
    
2. Educate patients about the different terms of Sonography:
   • Sonography - using the reflections of high-frequency sound waves (ultrasound) to construct an image (a sonogram) of a body organ or to observe fetal growth or study bodily organs.
   • Ultrasound – the use of ultrasonic waves for diagnostic or therapeutic purposes, specifically to image an internal body structure, monitor a developing fetus, or generate localized deep heat to the tissues.
   • Transducer – a device that receives a signal in the form of one type of energy and converts it to a signal in another form.
   • Sound wave – a wave that transmits sound
   • Sonographer – a specialist in the use of Sonography; a person who performs the sonographic exam (ultrasound).
      
3. Celebrate your accomplishments: A recent study found that 97% of ARDMS Registrants feel proud to have earned an ARDMS credential.  Share your accomplishments with colleagues and patients by displaying your credential certificate at your facility, sporting the ARDMS Registrant patches on your scrubs or lab coat, or wearing the ARDMS lapel pin. To place an order, click here.  
    
4. Encourage your colleagues to become credentialed: The reasons Sonographers become credentialed varies widely. According to an ARDMS survey, many active Registrants sought certification as a personal career goal, to distinguish themselves as competent in the field, to elevate the profession of Sonography, to expand career opportunities, or because it was a condition of employment.  Share your personal story about becoming certified with your colleagues and encourage them to join you in earning an ARDMS credential.
    
5. Be a Mentor: Offer to lend a supportive hand to students and those new to the profession of Sonography. Impart your clinical expertise through hands-on scanning, share the full scope of the day-to-day experience of a Sonographer, and encourage and celebrate efforts by others to become ARDMS certified. 
    

Check-out the Medical Ultrasound Awareness Month resources offered by other sponsoring organizations.

1. American Institute of Ultrasound in Medicine (AIUM)
2.  Society of Diagnostic Medical Sonography (SDMS)

CT Dose reduction

Interested in CT Dose reduction?
Greag Mason presented at RPAL this week

CT Dose Reduction

Greg Mason, Sapheneia.

Greg came from Clinton, Mississippi to teach about CT dose reduction. His company, Sapheneia, provides software technology to improve CT images taken with low dose imaging techniques. Greg outlined the technology required for dose reduction, inherent problems, and techniques to overcome these problems. The technology behind image improvement is iterative reconstruction, a model based imaging reconstructive technique that utilizes post processing to enhance image quality in both CT and CR x-ray. You can contact Sapheneia at http://www.scpab.eu/

More at RPAL

Building Your Business Through A New Technology

                Sherry Gage, Director, John C. Lincoln Breast Health and Research Center.

Sherry extended an invitation to all members to visit her site and see this new technology. 

Highlights of her talk are:

Tomosynthesis – 3d imaging in mammography

·         Storage issues

·         Exam scheduling

o   5 – 10 minute exam times

o   Decreased recall rates

o   Decreased tech time

o   Decreased room time

·         Challenges of increased patient demand for the technology

·         Can be done for screening

·         No 3D order needed from Dr.

·         Can be done with implants

·         Dose rates ~1mSv

·         Marketing 3D technology opportunities and challenges

At RPAL

Leveraging your investment in PACS

Mary Beth Wilson, Western Regional Sales Director for the TIMS DICOM System developed and manufactured by Foresight Imaging.

The TIMS DICOM System is a system for converting any non-DICOM medical modality to DICOM.

Highlights of the talk include:

·         All modalities are becoming PACS modalities – this is being driven by the need to create electronic medical records

            Centers need to develop a strategy for enterprise-wide imaging

·         PACS users will be leaders in this conversion

·         Key features of DICOM conversion devices

·         Utilization of PACS for

o   speech pathology studies

o   teleradiology consultation

o   mobile DICOM

RPAL ACR Update

Today at RPAL, lots of good stuff. Much of  it will have to be digested while I look over the links and resources we have available. Here is a summary of one talk we had:

2011 ACR Update

Howard Fleishon, M.D., Valley Radiologists and Medical Director at John C. Lincoln North Mountain Radiology.

ACR organizational structure was given with Arizona’s connections delineated. Arizona has had good representation at the ACR Council Steering Committee including representation in the past from Drs. Crowe, Levi, Owen and Ovitt.

ACR Nationally

Economic Realities of Radiology

Reimbursement policies in Washington D.C. are going to affect imaging. Specific areas government is looking at include ACA implementation (Obama-care), Self-referrals, and USPSTF reform particularly in mammography.

Viewpoint of the MEdpAC

A policy advisory group the MedpAC provides advisory services to CMS. It is the model that formed the basis for the Independent Payment Advisory Board created by the APA. Dr. Fleishon presented thinking behind MEdpAC’s recommendations as follows:

·         Industry data on imaging is showing a decrease of 7.1% volume, MEdpAC is reporting an increase of 2% volume.

·         Bundling of services/billing codes to create reductions in reimbursement; particularly reductions for multiple body parts seen the same day.

·         Government is determining billing codes, formerly this was the purview of the AMA

·         Up to 50% reductions for same-day utilization of a second imaging modality

·         CMS is examining the feasibility of prior authorization for advanced imaging services

·         According to MEdpAC the top 10% of physicians account for 50% of imaging orders

ACR Response to these pressures

·         Economics Commission submitted comments. Organized grassroots advocacy effort.

·         More cuts are expected to medicine in general and radiology in particular to meet the goals of government debt reduction.

·         The super-committee (Jon Kyle is a member) in Washington, formed to find savings, needs to be lobbied about how these changes will affect health care

·         www.radiologysaveslives.org

ACR Locally

The Maryland law is being held up in courts, limiting self-referral for advanced imaging.

Radiology assistants (Arizona is one of 29 states allowing practice). H.R. 3032 addresses reimbursement and ACR supports this bill

Scope of practice issues –

Iowa – board of nursing allowed nurses to perform fluoroscopy

                New Mexico – Nurse practitioners are allowed to perform any imaging exam.

www.RadPAC.org

                contributions to legislatures has increased from just over $500,000 in 2005 to $1,211,477 in 2010. RADPAC contributions on a percentage basis are high for medical professional organization but lower than other lobbying groups.

Through RADPAC, imaging centers can arrange for site visits by congressmen to see radiology departments and learn more about the work we perform. For more information, contact Ted Burnes tburnes@acr.org  this will allow legislators to spend approximately 1 – two hours touring and discussing work in the imaging center. RADPAC can arrange the details and logistics of the site visit and in selected cases will supply funding for campaign contributions.

ACR Advocacy Committee:

New effort to optimize national and encourage local efforts at grassroots advocacy. In Arizona, Dr. Fleishon recommends that we coordinate the resources of all imaging constituents in order to have an effective voice.

              

ACR Quality and Safety

·         Accreditation

·         Practice guidelines and technical standards

·         ACR National Radiology Data Regulations (NRDR)

o   Monitoring CT dosage

“Image Gently”

“Image Wisely”

ACR Education Center

                Opened March 2008

ACR Research

                ACR clinical research center ~50% ACR budget and staff

                ACRIN-ACR Investigative Network

RTOG Radiation Therapy Oncology Group

Other Resources

JACR – practice applications. Practiceleaders.acr.org

Bryan Dodd

There is a full-time sonographer position in Hawaii. General Abd, OB/Gyn & RVT needed. Contact:

http://www.facebook.com/nennetteespejocasino

Nennette Espejo-Casino

How to enter the program

I was asked if I have any advice to someone applying to help them get in the program. I would like to respond. Ultimately, the number of applicants we accept for the program depends on how many clinical sites we have available for students. If we are given enough sites to send students, we will take everyone who applies if they have the prerequisites completed. If we do not have enough sites, we have to find a way to determine who gets in and who does not. Our clinical sites we currently work with have stated that they prefer to work with students who have a health care background.

So number one, get a health care background. Go to school, volunteer, learn about what is involved in taking care of people. The more hours spent in health care, the better.

Next, realize that showing your expertise as a health care provider is considered. If you have a health care credential, you are a professional health care provider. This weighs heavily for applicants who have credentials. If you can earn a credential, it shows that you are a professional and our clinical sites are more likely to accept you.

Finally, Apply! many people assume that it will be hard or impossible to enter the program so they do not apply. We will take someone else to fill that slot.

If you know of an imaging center which uses ultrasound and is not a current clinical site, ask them if they would consider becoming a site for us. We like working with a variety of sites as it allow our students to get the broadest education possible. Our goal is to have the best sonographers graduating from our school to serve our community.

New Class Starting

Well, we are starting a new class and for the first time it is starting before we graduate the senior class. Why? because last time we took off time to give our clinical sites a break, they dumped us and started using other schools. We just can't lose sites that way.

DMS 150 Lab 1

Physics DMS150: Lab I
Speed of Sound

Part I: Speed of sound in Air
This portion of the lab is to be done outside in the west parking lot (light-rail park-and-ride) between Washington and Van Buren.

Step One:
Divide into two teams and go to the parking lots on the west side of campus.
Team one takes air horn
Team two takes stopwatch and air horn
Move apart as far as you can (note you will need to know the distance between teams).
Team 1 visually signals as they sound the air horn (cell phones also work).
Team 2 will start the stopwatch when they see the visual cue, and stop the stopwatch when they hear the air horn.

Record:
The distance from the listener to the source. 180m
The time recorded for the sound to travel from source to listener. 0.34 sec
Make at least three measurements.

Step two:
This time we will record the round-trip time elapsed.
Team one takes the air horn and stopwatch
Using the same distance between teams
Team one visually signals and starts the stopwatch as they sound the air horn.
Team two signals when they hear the air horn and sounds the second air horn.
Team one stops the stopwatch when they hear the second air horn.

Record:
The distance between teams. 180m
Total time for sound to travel from team one to team two and back to team one. 1.44sec
Make at least three measurements.
Using the distance equation from your textbook, calculate the speed of sound in the air.

What is the speed of sound in air ________________?
Distance/time = rate 360m/1.44 sec = 250 m/s

Part II: Speed of sound in tissue and fluids
This portion of the lab can be done in the ultrasound lab
Cut a piece of tissue mimicking material at least 1.5cm thick and place in a container of water.
Measure the depth of the water and the tissue mimicking material using an ultrasound machine. Record this as the thickness of the slab or water.

Using a linear array probe, take a picture of the tissue mimicking material and water.
Measure the depth of the water and the tissue mimicking material on the ultrasound image.
Enter the measurement for water here __3.77cm____ this is D1
Enter the measurement for the tissue mimicking material as measured in the water _1.88cm_ This is D2
Enter the measurement of the tissue mimicking material as measured through the material ____1.53_ This is D3

What speed of sound does the machine assume? __1540m/s___
How much does the measurement of the tissue mimicking material as measured in the water differ from the measurement of the tissue mimicking material as measured through the material itself? 1.88cm – 1.53cm = .35cm This is D4

Numbers needed to calculate the speed of sound in the tissue mimicking material.
Thickness of slab (2) = D2
Speed of sound in slab = VS
Assumed speed of sound = VA Use: 1540 m/s
Difference in depth = D4

The next section shows how to use this information to calculate the speed of sound in tissue mimicking material For the time interval “t”, the sound beam actual traveled:

t=D2/Vs
For the same time interval “t”, the machine calculated the sound beam to have traveled:
t=(D2-D3)/VA
Therefore:
t=(D2-D3)/VA= D2/Vs
Now you need to use algebra we can solve for t and then substitute to solve the equations for VS
VS=VA/(1-D3/D2 )
Using the above equation calculate the speed of sound in the tissue mimicking material.VS=1540m/s÷(1-(.35cm)/(1.88cm))
VS=1540m/s÷(1-.186)
VS=1540m/s÷.8138
VS=1892m/s



Part III: BONUS – Speed of Sound in Tissue Mimicking Material

Recalculate the speed of sound in the tissue mimicking material using the actual speed of sound in water. (Note: this requires that the machine measurements be adjusted before calculating the speed of sound in the material.)

Recently from the AIUM...

AIUM Announces Ultrasound Practice Accreditation in Fetal Echocardiography
The AIUM recently announced that ultrasound practice accreditation is now available in fetal echocardiography. The program sets the standard for care in fetal echocardiography and builds on the development of AIUM guidelines aimed at fostering its safe and effective use.

"I am proud that the AIUM has designed a way for health care providers to show that they meet or exceed training and performance guidelines in this highly specialized exam," said AIUM President Harvey L Nisenbaum, MD

The announcement of ultrasound practice accreditation in fetal echocardiography builds on the recent publication of the AIUM Practice Guideline for the Performance of Fetal Echocardiography and on modifications made to the AIUM Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Ultrasound Examinations.

Under the updated training guidelines, completion of an American Board of Obstetrics and Gynecology- or American College of Osteopathic Obstetricians and Gynecologists-approved fellowship in maternal-fetal medicine and a written description of experience in performance of fetal echocardiography may be accepted as proof of sufficient training in fetal echocardiography. Practitioners in other specialties, including pediatric cardiologists and radiologists, can demonstrate education and skills by submitting a narrative of their experience.
Ultrasound practice accreditation is a voluntary peer-review process that measures practices against nationally accepted protocols in training, practice, and safety. Practices that achieve accreditation show that they meet or exceed these standards. It is anticipated that practices accredited in dedicated fetal echocardiography be more likely to receive payment for the examinations.
Fetal echocardiography uses ultrasound to examine the structure of a fetus' heart. A fetal echocardiogram offers greater detail than routine obstetric ultrasound. Women identified as being at high risk for delivering a baby with birth defects are often referred for fetal echocardiography.
Applying for accreditation or reaccreditation is now easier than ever, thanks to our new streamlined online application.

Additional Resources:

Step-by-Step Guide

Getting Started Video (Earn a free CME credit after watching the video.)

Why Seek Ultrasound Practice Accreditation? Video