Musculo-skeletal test of mortality w/o Echocardiography Training

Echocardiography Training

Without Echocardiography Training test your mortality.

Today I came across an interesting article that deals with mortality predictors based on musculo-skeletal fitness.  I realize this information doesn’t fit our usual postings of Echocardiography Training and Ultrasound in general, but I found it interesting and so might you.

What they said:

Ability to sit and rise from the floor is closely correlated with all-cause mortality risk

Test of musculo-skeletal fitness is ‘strong predictor’ of mortality in the middle-aged and older

“If a middle-aged or older man or woman can sit and rise from the floor using just one hand – or even better without the help of a hand – they are not only in the higher quartile of musculo-skeletal fitness but their survival prognosis is probably better than that of those unable to do so.”

I was surprised:

I actually watched the video accompanying the story and tried the test for myself.  After taking some Aleve and practicing, I was able to complete the test only using one support.   Just kidding, but this actually is a little more complicated than I would have thought.  I received a score of 4 with isn’t bad but not the best.

Take a look at this article and watch the video.  I think everyone should try this.  Very easy test, you can complete yourself at home.

The link is : http://www.escardio.org/about/press/press-releases/pr-12/Pages/ability-to-rise-correlated-mortality.aspx?hit=dontmiss

Outlook:

If any of our readers review this and try it comment on this and let everyone know what you thought.  Also if you know more about this subject comment also.

As always we will continue to bring interesting stuff from the medical field to our readers.

As always if this info was interesting for you,  like it and share it with your social networks.

By John Sheldon

How the Future of Ultrasound hinges on Election…..

Ultrasound in hands of BossJust a quick thought today about healthcare in general and Ultrasound’s and Sonography’s future in specific.  This will effect all modalities including Echocardiography (Cardiac Ultrasound), Vascular Sonography and General (OB/GYN)  Ultrasound.

As many of you are already aware the Obamacare law has slashed the reimbursements for Echocardiography, Vascular Ultrasound, and General Ultrasound.  This has had, in my opinion, a great influence on the number of Echocardiographers, Vascular Techs and Ultrasound Techs being hired.  Many facilities have gone to PRN sonographers in leu of full time positions.  Thus the final symposis is their are very few jobs being offered right now, at a time when graduate numbers are increasing.  Also added to this is that when fully implemented, Obamacare, will greatly increase the number of patients requiring Echo, Vascular, and Ultrasound studies.  So while lowering reimbursements, causing fewer techs, raising the number of studies requested.  Sound like a formula for wait lists, shortages, etc?  We at the Academy are already noticing many imaging centers and Dr. offices no longer offering inhouse studies. (More Echo, Vascular, and Ultrasound techs without employment)  This will greatly influence Echocardiography Training and Vascular Training and Ultrasound Training.  It is more important than ever to attend a program that has passing the ARDMS or CCI registry as part of their curriculum.

So back to the thought for today. I came across this article dealing with the future of Healthcare after the Election.  It discusses both alternatives, considering the election outcome.

A short excerpt:

“the future of ObamaCare is at stake in next week’s elections. If President Obama wins and Democrats hold the Senate, the Affordable Care Act will survive. If Mitt Romney wins and Republicans take the Senate, the law is dead. It is the starkest of differences”

You can find the remainder of the article at:

http://thehealthcareblog.com/blog/2012/11/02/healthcare-law-on-the-ballot/

No matter how your political views swing, I feel that the Healthcare law and its future will have a dramatic impact of the future of Echocardiography, Vascular and General Ultrasound jobs going forward.

As always if this info was interested like it and share it with your social networks.

By John Sheldon

Sonographer: 2nd Best Paying Job in the Future

Diagnostic Medical SonographyGreat News for Sonography!

24/7 Wall St just released a report that reviews and ranks the 10 Best paying jobs of the Future. 

Sonography made #2 on the list. 

They reviewed many criteria, including growth, salary and requirments for the jobs.  As expected jobs in the medical field topped the list.  The most interested part of the medical jobs was the following:

“Because most of these positions are in the medical field, many require at least a master’s degree, and in many cases a doctoral degree. However, four have less demanding educational requirements, including the three that are growing the most. A career as a sonographer, projected to grow 43.5% with a median salary of $64,380, typically just requires an associate’s degree”Sonography includes many different specialities under the heading of Diagnostic Medical Sonographer.  Some of them include Echocardiography (Cardiac Ultrasound), Vascular Sonography, Abdominal Sonography, OB/GYN Sonography, and others.
 
Here is the excerpt of their review on Sonography: 

2. Diagnostic Medical Sonographers
> Pct. increase:
43.5%
> Total new jobs (2010-2020): 23,400
> Median income: $64,380
> States with the most jobs per capita: Rhode Island, Florida, South Dakota

Diagnostic medical sonographers work in hospitals and other facilities, conducting ultrasounds on patients and analyzing the resulting images. The BLS projects an increase of 43.5% in the number of positions between 2010 and 2020, which would raise the total number of such jobs to 77,100. Explaining the driving factors behind the growth, the BLS states that “as ultrasound technology evolves, it will be used as a substitute for procedures that are costly, invasive or expose patients to radiation.” Sonographers typically need an associate’s degree, and many employers prefer candidates to have professional certification. The top 10% of sonographers made more than $88,490 annually.

Read more: The Best Paying Jobs of the Future – 24/7 Wall St. http://247wallst.com/2012/08/30/the-best-paying-jobs-of-the-future-2/#ixzz28zjtSZpL

 
As this report points out Sonography remains as one of the top fields to pursue.  Especially given that it can be accomplished with under 2 years of higher education.  The salary ranges reported are still in the higher level of jobs with and associate degree or less. 
 
If you are thinking about Sonography, check out The Academy of Ultrasound, LLC.  They offer their Sonography programs in 18 months including passing the national registry.  Which by the way, is generally a requirement for immediate employment.
 
As always, if you found this info interesting, like us and share this article with your social networks.
 
 

Echocardiography used as Henry Doorly Zoo gorillas screened for heart disease

Gorilla Echocardiography

I was browsing ultrasound articles this morning and came across an interesting piece.

Apparently gorillas in captivity suffer from Heart Disease, as one of the major killers.  This is surprising since they don’t engage in any of the destructive behaviors that are thought to be contributors to human heart disease.

With the increasing use and image quality of portable echocardiography machines, Drs are not able to perform ultrasounds on the gorillas while awake.  This is amazing, the gorillas are trained to allow the echocardiogram to be performed while the stay calm and relaxed.  Wish we could train some of our ultrasound patients to do the same.

Just shows us that the future of Ultrasound and Echocardiography is always expanding into uncharted territory.  Check out the full story at the link below.

Henry Doorly Zoo gorillas screened for heart disease – Omaha.com.

If you liked this article be sure to share with your internet friends on facebook, twitter, etc.

Good luck with your future scanning.

By John Sheldon

 

Explaining Echocardiography and the Transthoracic Echocardiogram

Transthorasic EchocadiogramSince starting the Echocardiography program at the Academy of Ultrasound, LLC, we are constantly looking for new and improved reference materials.  The hope is to better explain, to our students and patients, what we as sonographers do and what the ultrasound test is.

One of the spots we frequent is the Family Practice Notebook (www.fpnotebook.com).  Recently we found a new outline formatted description of an Echocardiogram.  Its a great synopsis, complete with references to common terms and images. 

Below is their description.  Review it and leave any comments you might have.  We feel it will help with your understanding of the basic Echocardiography exam.

If you like it be sure to share this with your friends.

 

 

 Transthoracic Echocardiogram

See Also

    1. Transesophageal Echocardiogram
    2. Echocardiogram in Congestive Heart Failure
    3. Stress Echocardiogram
  • Background
    1. Use Phased-Array transducer (1-5 MHz)
      1. Faster frame rate to catch dynamic images throughout cardiac cycle
      2. Use cardiac preset
        1. Transducer marker corresponds to screen right (contrast with other presets where marker is on screen left)
    2. Most patients will have one adequate view to visualize heart function
      1. Quality of view is inversely proportional to body habitus (i.e. Obesity degrades the view)
      2. However, technique for a single view can be modified to visualize most structures
    3. Emergency Echocardiography (or Focused UltrasoundExamination) does not replace a complete Echocardiogram
      1. Emergency Echocardiogram is done to answer specific emergency related questions
  • Precautions
    1. Pericardial Effusion
      1. Features
        1. Pericardial Effusion will surround the heart and should be seen in multiple views
        2. Pericardial fluid moves in opposite direction as heart wall
        3. Cardiac Tamponade
          1. Right heart wall movement will be paradoxical rocking motion
            1. Right atrium collapse in systole (also occurs with hypovolemic shock)
            2. Right ventricular collapse in diastole
      2. Differential diagnosis (look-alikes on Echocardiogram, confirm in multiple views)
        1. Pericardial fat pad (moves with heart wall)
        2. Descending aorta
  • Indications: Emergency Echocardiogram
    1. Cardiac Arrest
      1. Cardiac standstill
        1. Distinguish from Ventricular Fibrillation appearance (shimmering appearance of ventricular wall)
        2. Distinguish from lung excursion with Positive Pressure Ventilation (stop PPV to visualize heart activity)
        3. Prolonged cardiac standstill may demonstrate congealed blood in ventricle
        4. Associated with little to no chance of survival (helps direct cessation of code)
          1. Blaivas (2001) Acad Emerg Med 8:616
      2. Identify reversible causes of PEA
        1. Cardiac Tamponade (Pericardial Effusion and right ventricular collapse in diastole)
        2. Hypovolemic shock (hyperdynamic heart with with small ventricular chamber)
        3. Pulmonary Embolism (new dilated right ventricular chamber)
        4. Myocardial Infarction (new wall motion abnormality, decreased contractility or EF)
    2. Shock or Hypotension
    3. Acute Dyspnea
    4. Trauma
      1. See FAST Exam
    5. Myocardial Infarction
    6. Ultrasound-Guided Pericardiocentesis
  • Views: General
    1. Parasternal Echocardiogram View
      1. Parasternal Long-Axis Echocardiogram View
      2. Parasternal Short-Axis Echocardiogram View
    2. Apical Echocardiogram View
    3. Subcostal Echocardiogram View
    4. Suprasternal Echocardiogram View
  • Views: Parasternal Long-Axis Echocardiogram View
    1. Improved window (bring heart closer to transducer and reduce rib shadowing)
      1. Patient positioned in left lateral decubitus position
      2. Start along sternal border near the 3rd interspace and check several interspaces inferiorly and laterally
    2. Transducer orientation
      1. Transducer 3-5 cm to the left of the left sternal border at the 3rd to 5th intercostal space
      2. Transducer indicator pointed towards patient’s right Shoulder (10:00 position)
    3. Images
      1. UltrasoundHeartPLAXAndPSAX.jpg
    4. Landmarks
      1. Right ventricle or right ventricular outflow tract
      2. Left ventricle, aortic valve and proximal aorta
      3. Mitral valve and left atrium
      4. Descending Aorta
    5. Conditions
      1. Visualizes the positions of the parasternal short axis cross sections (see below)
      2. Wall motion abnormalities (especially apex and septum)
      3. Valvular insufficiency (Mitral Regurgitation or Aortic Insufficiency) with color doppler
      4. Aortic root dilation (best imaged with same probe orientation but at the 3rd intercostal space)
      5. Left ventricular Systolic Dysfunction(CHF)
        1. Decreased contractility of left ventricle
          1. Normal
          2. Depressed or severely depressed
          3. Hyperdynamic
        2. Decreased ejection fraction
          1. Gross Estimate
            1. Estimate visually what percentage difference is seen between the left ventricle volume in systole and diastole
            2. M-mode compare end-systolic (ESD) and end-diastolic (EDD) diameters
          2. Linear calculation: Ultrasoundcalc package
            1. In M-Mode, measure end-diastolic (EDD) and end systolic (ESD) diameters
            2. Ejection fraction = 100 * (EDD^3 – ESD^3) / EDD^3
        3. Dilated left ventricle (end diastolic diameter >56 mm)
          1. Measure across widest point between septum and posterior wall
          2. Chordae tendinae may obscure true posterior wall
        4. E-point septal separation (EPSS) on M-Mode or cine
          1. Distance between the septum and the mitral valve leaflet when maximally open
          2. Normal is <8-10 mm (>20 mm is correlated with an EF<30%)
  • Views: Parasternal Short-Axis Echocardiogram View
    1. Transducer orientation (start)
      1. Transducer Rotated 90 degrees clockwise from Parasternal Long Axis View
      2. Transducer 3-5 cm to the left of the left sternal border at 3rd to 5th intercostal space
      3. Transducer indicator pointed towards patient’s left Shoulder (1:00 position)
    2. Transducer gradually tilted down heart axis to obtain 4 heart cross-sectional slices
      1. Aortic valve level
      2. Mitral valve level
      3. Mid-ventricle level
      4. Heart apex
    3. Images
      1. UltrasoundHeartPLAXAndPSAX.jpg
    4. Landmarks: Aortic valve level
      1. Right ventricular outflow tract
      2. Tricuspid valve, aortic valve (peace or mercedes sign when tri-leaflet) and pulmonic valve
      3. Right atrium, left atrium and pulmonary artery
    5. Landmarks: Mitral valve level
      1. Right ventricle
      2. Mitral valve (anterior and posterior leaflets appear as a fish mouth opening and closing)
    6. Landmarks: Mid-ventricle level
      1. Right ventricle
      2. Left ventricle (with trabeculations representing papillary muscles)
    7. Landmarks: Apical level
      1. Right ventricle (much smaller in size than left ventricle unless right ventricle dilated)
      2. Left ventricle
    8. Conditions
      1. Bicuspid aortic valve (Aortic valve level)
      2. Left ventricle wall motion abnormality (mid-ventricle level)
        1. Best view to see all left ventricle walls
  • Views: Apical Four Chamber Echocardiogram View
    1. Transducer orientation
      1. Transducer placed at PMI or approximately xiphoid level (6th intercostal space) in mid-clavicular line or nipple line
      2. Transducer indicator pointed towards patient’s left (3:00 position)
      3. Align energy toward right Shoulder along heart’s long axis
      4. Hand holding transducer is pushed with knuckles into the bed to get best angle through heart
    2. Landmarks: Four chamber heart view
      1. Right ventricle and left ventricle
      2. Tricuspid valve and mitral valve
      3. Right atrium, left atrium and descending aorta
    3. Conditions
      1. Pericardial Effusion
      2. Apical thrombus (decrease depth to see, apex is closest to probe in this location)
      3. Systolic Dysfunction
      4. Wall motion abnormalities
  • Views: Subcostal Echocardiogram View (or subxiphoid view)
    1. See FAST Exam
    2. Pearls to improve view window
      1. Consider starting this view longitudinally with indicator at 12:00 to identify left lobe of liver and angle through heart
      2. View improves with the patient taking a deep inspiration
    3. Transducer orientation
      1. Hold transducer over the top (more at the base of probe) to allow for a more shallow angle
      2. Push the transducer down (posteriorly) to drop below (deep) to the xiphoid process
      3. Transducer placed sub-xiphoid (by 1-2 cm) in superior epigastrium
      4. Transducer indicator pointed towards patient’s right (9-10:00 position) with energy toward left Shoulder
    4. Landmarks
      1. Four chamber heart view
      2. Increase angle of approach (aiming more posterior) if aorta is seen in the four chamber view
    5. Conditions
      1. Pericardial Effusion
      2. Systolic Dysfunction
      3. Wall motion abnormalities
  • Views: Subcostal Longitudinal (volume status view)
    1. Pearls to improve view window
      1. View improves with the patient taking a deep inspiration
    2. Transducer orientation
      1. Transducer placed right lateral to sub-xiphoid
      2. Transducer indicator pointed towards 12:00 with energy toward left atrium
    3. Landmarks
      1. Inferior vena cava
      2. Right atrium
    4. Conditions
      1. Volume depleted (e.g. Hemorrhagic Shock, dehydration)
      2. Volume overload (e.g. Congestive Heart Failure)
    5. Interpretation: Volume status based on IVC alone
      1. Inferior vena cava (IVC) is normally 1.5 to 2.5 cm in diameter (measured 3 cm from atrium)
        1. IVC <1.5 cm suggests volume depletion
        2. IVC >2.5 cm suggests volume overload
      2. Inferior vena cava (IVC) normally collapses more than 50% with inspiration or sniffing
        1. Total collapse suggests volume depletion
        2. Collapse <50% suggests volume overload
      3. Correlation between RA pressure (CVP) and IVC appearance
        1. CVP 0-5 cm: IVC totally collapses on inspiration and is <1.5 cm in diameter
        2. CVP 5-10 cm: IVC collapses >50% on inspiration and is 1.5 to 2.5 cm in diameter
        3. CVP 11-15 cm: IVC collapses <50% on inspiration and is 1.5 to 2.5 cm in diameter
        4. CVP 16-20 cm: IVC collapses <50% on inspiration and is >2.5 cm in diameter
        5. CVP >20 cm: No change in IVC on inspiration and is >2.5 cm in diameter
    6. Interpretation: Volume status by Caval Aorta Index
      1. Step 1: Measure maximal internal IVC anteroposterior diameter (in M Mode)
        1. Subxiphoid level in longitudinal axis
        2. Measure just caudal to confluence of hepatic veins
      2. Step 2: Measure maximal internal aorta anteroposterior diameter (in M Mode)
        1. Subxiphoid region in longitudinal axis
        2. Measure just to the left of the IVC
      3. Step 3: Calculate the Caval Aorta Index as IVC/Ao
        1. CVP <7 cm H2O: Caval Aorta Index of 0.72 (+/- 0.09)
        2. CVP 8-12 cm H2O: Caval Aorta Index of 1.23 (+/- 0.12)
        3. CVP >13 cm H2O: Caval Aorta Index of 1.59 (+/- 0.05)
      4. Reference
        1. Sridhar (2012) ISRN Emergency
  • Views: Suprasternal Echocardiogram View
    1. Transducer orientation
      1. Transducer placed in suprasternal notch
      2. Transducer indicator pointed towards 9:00
      3. Align energy inferiorly (towards feet) until arch comes into view
      4. Rotate transducer clockwise until arch is in full view
    2. Landmarks
      1. Brachiocephalic artery, Left Carotid Artery, Left subclavian artery
      2. Aortic arch
      3. Right pulmonary artery
      4. Left atrium
    3. Conditions
      1. Aortic Dissection
      2. Aortic aneurysm
  • Resources
    1. Sub-xiphoid View Video (SonoSite)
      1. http://www.youtube.com/watch?v=1UJ6RodOSTw
    2. Apical 4-Chamber View Video (SonoSite)
      1. http://www.youtube.com/watch?v=_eHZz-OCc_M
    3. Parasternal Long Axis View Video (Sonosite)
      1. http://www.youtube.com/watch?v=4qerzEW_ASU
    4. Parasternal Short Axis View Video (SonoSite)
      1. http://www.youtube.com/watch?v=EaLuCBXXINg
    5. Suprasternal Notch View Video (Sonosite)
      1. http://www.youtube.com/watch?v=Mkc6tUVRgKo
    6. Inferior Vena Cava UltrasoundVideo (SonoSite)
      1. http://www.youtube.com/watch?v=ci9W4MvyMHI
    7. Echocardiographer
      1. http://echocardiographer.org/
  • References
    1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete’s Beach
    2. Noble (2011) Emergency and Critical Care Ultrasound, Cambridge University Press, New York, p. 61-88
    3. Reardon (2011) Pocket Atlas Emergency Ultrasound, McGraw Hill, New York, p. 61-106

By John Sheldon

Cardiovascular (Echocardiography) and Vascular Sonographers: Updated salary and job information as of 2010 data

Cardiovascular exam

We are all affected by today’s unpredictable economy.  This fact makes it a bit difficult for someone to determine what career path to choose or to even change your existing career path.  So, we are now forced to research longer and deeper than we would have before in order to make the best decision when deciding on what we want to do with our life.  There are a few important facts when considering a career path or change which include work environment, salary, and the predicted future of the chosen field.

When considering sonography, you must first decide which modality would be the best “fit” for you.  Let us take a look at two of the modalities.  For example:   Cardiovascular (Echocardiography) and Vascular Sonography.

Cardiovascular, sometimes referred to as “Echocardiography,” is where the technician uses diagnostic imaging to assist the physicians in the diagnoses of cardiac (heart)  ailments in patients.

Vascular sonography is where the technician uses diagnostic imaging to assist the physicians in the diagnoses of peripheral (blood vessel) vascular ailments in patients such as blood clots.

The work environment for both Cardiovascular and Vascular sonographers are similar.  These technicians usually work in a healthcare facility such as a hospital, clinic, and/or a physician’s office.  Now, another possibility is to work for a “mobile” service where the sonographer is employed by the “mobile” company that is contracted by a physician (physician’s office) who schedules regular patient appointments on a certain day(s) during the month, for example.

As of May 2010, according to the U.S. Bureau of Labor Statistics, the average starting salary for cardiovascular and vascular technicians is around $49,410.00 per year.  This equates to about $23.75/hour.  The job outlook over the next ten years in this field is expected to increase approximately 29%, which is much faster than the average.  Basically, the increase is due to the evolution of technology allowing medical facilities to replace more invasive procedures with less costly ones.

Patient comfort is important during exam.

Even though hosptials are the primary employers of cardiovascular and vascular technicians, it is predicted that employment will grow more rapidly in physicians’ offices as well as in diagnostic laboratories due to the shift toward outpatient care whenever possible.

In summary, it will also be important to make yourself as “marketable” as possible.
In order to ensure your marketability as a potential employee, it makes sense to be as prepared as possible.  In the world of diagnostic medical imaging, this includes – not limited to- being registered in more than one ultrasound modality.  For example, it is becoming more and more familiar to hear that an employer is looking for a “dual” registered candidate.  This may mean holding dual registries such ash General and Vascular, or Echocardiography/Cardiovascular and Vascular, etc.  Some employers will interview a registered candidate witht the requirement being that the person will sit for the other registry within  six months to one year.  This scenario is becoming more and more common.
With the predicted employment of 63,900 technicians by the year 2020 as Cardiovascular and Vascular technicians, it is imperative to be ready.
Contact us at (866) 867-2824 for information on our next online “cross-over” course in Cardiovascular/Echocardiography and Vascular ultrasound.  Our courses begin on the 1st of each month.