Ultrasound Training starting Parties

Ultrasound Training used for Parties

Ultrasound Training is now including Parties

The newest frontier expansion for using your Ultrasound Training is in the field of an Ultrasound Party.  Talk about pregnancy oversharing.  I recently saw this article and wanted to share it with you.

What it’s about

Todays Mom Website posted this article about a new group of Ultrasound Studies that are quickly growing.  Several companies are getting into this new area of OB/GYN Ultrasound.  The tech comes to your home or location and you , your family and friends can watch a live ultrasound of your baby.  The article is located here, for your review.




What do you think about Ultrasound Parties

After reading this article, I want you to ponder the ethical and legal issues that this form of Ultrasound can effect.  Then comment on this and let me know what your thoughts are .  The article mentions some interesting byproducts of using Ultrasound Training and Machines for this type of for-profit activities.


As always if you like this article, like it and share with your social networks.



John Sheldon RCS RVS

Virtual Echocardiography Training

Vita Echo Echocardiography Virtual TrainingJust announced last night is a new breakthrough in the world of Ultrasound, specifically Echocardiography Training.

As you know the Academy of Ultrasound, LLC, has an established Echocardiography program offering online training for new Echo Techs.  One of the greatest challenges is providing online students with practice and visual aids, on the performance of the actual Echocardiogram.  The distance format makes this an even greater concern.  To date, the Academy of Ultrasound, LLC is offering visual aids in the form of pictures, videos of Echocardiograms both performed and being performed.  This has been the standard, in Online Echocardiography training since its start.

Now the good news.  A company named Vita Systems has created a Virtual Echocardiography Training software to solve these concerns.  This product, dubbed VitaEcho was announced on 10/24/12 at a conference in Miami, Fl.  They describe the product as,

“a software platform designed to teach the mechanics of echocardiography, before a practitioner ever encounters a live patient”

The official description is,

“The VidaEcho system features a simulated 3D anatomy of the heart, and the corresponding echo image.  By moving a virtual echo probe handle with a mouse, users learn how the device will interact with cardiac anatomy.  The application features an intuitive user interface and highly realistic depictions of the heart’s anatomy and ultrasound, with both transesophageal (TEE) and transthoracic (TTE) modes available.  The system offers preset views but can also be customized.  Features also include the ability to overlay the echo image onto the 3D anatomy, so that the practitioner can internalize the translation of 3D anatomy to 2D images, a common hurdle for mastering echocardiography learning.”

So now we are beginning to get training products that can help Online Echocardiography Training programs to give thier students a visual and hands on way of developing hands on skills and begin to visualize the cardiac anatomy in 3D.  This will help immensely in the Echo Students comfort before they begin the clinical portion of their Echocardiography Training.

Although the announcement of the VitaEcho system has happened, the product hasn’t become officially available just yet.  Since this product is in the cloud, and software based, we at the Academy of Ultrasound, LLC are hoping the pricing will allow us to take advantage of this breakthrough in Online Echocardiography Training.  Check back and we will continue to update this story as Vita Echo becomes available for use.

As always, if you found this info interesting, like us and share this article 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:
> 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.

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

Ultrasound Specialties and Modalities Available

One of the most common dilemnas a potential ultrasound student faces is which modality to consider.  Most people considering ultrasound as a possible career choice are unaware of the different areas of specialization available to them.  Thus, the main focus of this blog post is to educate the public on the possibilities in the field of sonography.  In an effort to keep this particular post as short and concise as possible, as to not be boring, I will publish a series of  THREE blog posts on the subject of the specialties and modalities available.  So, be sure to visit our blog for the upcoming posts.

First of all, it is not necessary to become a Diagnostic Medical Sonographer (DMS) prior to choosing a specialty.  There seems to be a misconception that one must receive General Ultrasound training before completing the training for a specialized area; this is not so.  However, it is the decision of the trainee as to the length of training willing to persue.  With that in mind, it is possible to seek – for example, training in Echocardiography without receiving certification in another modality, first.

General Ultrasound imaging

The areas of specialization being discussed in this post are:


  1. Abdominal and Small Parts – these sonographers produce images of organs or organ systems within the abdominal cavity of the patient. The abdominal cavity includes: liver, biliary system, spleen, pancreas, urinary system, breast, thyroid, great vessels, and male reproductive system. The images that are produced assist physicians in diagnosing and treating certain diseases and disorders.
  2. Obstetrics and Gynecology (OB/GYN) – the female reproductive system is the focus of the images made by these sonographers. Naturally, the most common association of ultrasound imaging is that of a pregnant woman where the doctor monitors the growth and health of the fetus.
  3. Breast Sonography – one of the tools used to fight breast cancer. Tumors are often detected by using ultrasound images of the breast tissue and blood supply. Mammography is often coupled with mammography.
  4. Neurosonography – sonographers produce ultrasound images of the nervous system which includes the brain. It is common for Neurosonographers to work in neonatal care which includes diagnosing and studying the conditions of the neurological and nervous system of premature infants.


It is a fact that sonographers who are registered in more than one modality strengthen their marketability; therefore, resulting in increased salaries.  While working at just one facility – such as a hospital- may be attractive to some, it is possible for sonographers to seek employment with an additional facility – such as a private practice – using another specialty. For example, if you are employed as a full-time Echo Tech at a hospital and are also registered as a  Vascular Tech, you may choose to work for a private practice on a part-time basis or even weekend “call” basis.  This is just one example of using multiple modality certifications to advance career and earnings potential.

The credentials associated with the above modalities (others will be mentioned in upcoming series posts) provided by the American Registry for Diagnostic Medical Sonography (ARDMS) are:

  • RDMS – Registered Diagnostic Medical Sonographer


For the next modality to be discussed in this series, be sure to visit our blog next week.

(Please view our previous posts such as “The Truth: Accredited v. Non-accredited” )

www.academyofultrasound.com  For information regarding online ultrasound program, email: info@academyofultrasound.com