How to Become an Ultrasound Boss: Tips for Developing your confidence in Small Animal Abdominal Ultrasound.
Developing competency and confidence in ultrasound as a new graduate or beginner sonographer can seem like a daunting task. Experience has highlighted key issues that are encountered by vets across the board, and we have collated some simple steps that we believe will greatly expediate your development into an ‘Ultrasound Boss.’
- Get an honest assessment of your equipment.
There is no point wasting precious time and energy trying to improve your ultrasound skills if the machine in your practice is not fit for purpose. The banged up old sheep scanner, or the thirty year-old gargantuan with an endo-cavity probe donated by the local gynaecologist, are not doing you or the practice’s standard of care any favours. Your ability to make a diagnosis is directly related to the quality of the image the machine is able to produce. If you can’t see it clearly, how can you diagnose it with confidence?
Action: Reach out to an ultrasound equipment sales representative or applications specialist. They should be more than happy to assess your needs, and can give advice regarding existing equipment. Ask for demos on all the systems you are looking at (even across different suppliers) to enable you to make the most informed decision.
- Learn how to use your machine, including basic image optimisation.
It’s not uncommon to hear vets saying that they ‘are afraid to touch buttons in case they break something’ when speaking about their ultrasound machine. When in doubt, just remember that ultimately it’s just a computer with a funny-looking keyboard… and there is nothing you can press that can’t be reset!
Basic image optimisation should be included in learning how to use your machine, and this is an important and often-overlooked fundamental skill. An experienced sonographer will optimise their image throughout a scan, as they know that their ability to perform a thorough exam and recognize abnormalities is directly associated with their ability to make the image as clear as it can be.
Just as using incorrect exposures when taking a radiograph will hamper your ability to make a diagnosis, so will poor image optimisation hamper your ability to perform a diagnostic ultrasound scan, even with the fanciest of equipment.
Action: If you haven’t done so already, ask your equipment supplier to provide a training session with your machine, or find some resources online available for your ultrasound model. You can then sit and dedicate some time familiarising yourself with your machine’s functionality.
- Go on a course… appropriate to your level of experience.
Courses are really beneficial as they cover fundamentals such as image optimisation, but also teach you systematic techniques to approaching each organ. This helps you to ascertain more confidently whether you have examined all the organs in their entirety. Additionally, they will also provide insight into recognising pathology and how this differs from normal. Don’t make the mistake of jumping onto an intermediate or advanced course until you are fully confident with the basics… Rome wasn’t built in a day!
Action: There are many courses out there. Look for a course with a solid practical component as a beginner scanner. An approachable, patient teacher is always a win, but even more so as a beginner when scanning feels as awkward as writing with the wrong hand.
- Scan, scan, scan… whilst creating an environment more conducive to your learning.
Scan as many cases as you can. In the beginning this might involve scanning a case at no cost to the owner or scanning your own pets repeatedly. (My own dog is a long-suffering ‘victim’ of this). As a beginner, giving yourself fifteen minutes to scan a struggling patient with the owner waiting will serve only to frustrate you and cause you to doubt your abilities, as well as cheating the owner of the full diagnostic potential of the modality. Admit patients as procedures, ensure they are adequately starved, and block off enough time (at least 45 minutes as a beginner) to scan slowly and systematically.
Sedation (with or without analgesia as appropriate) is your friend, and the patient’s friend. Many of the patients we are investigating using abdominal ultrasound have a degree of abdominal discomfort and pain, and they may be ill and stressed. If the patient is struggling and boarding their abdominal musculature, your job of examining certain areas (particularly in the cranial abdomen) becomes unnecessarily difficult, as well as unpleasant and stressful for the patient. Sedation will greatly facilitate the process and enhance your ability to provide the owner with the most valuable diagnostic information for the money they are spending.
Action: Discuss this with other team members and agree on a system or protocols that work for everyone. Don’t forget that when you upskill yourself this directly benefits the practice in the longer term by improving the standard of care and increasing income, which can outweigh any short-term inconvenience of taking longer for scans when you are still a beginner.
- Find a mentor, keep learning.
Some of you will be lucky enough to have a colleague in your practice who is able to mentor and oversee your scanning journey. Other’s might not be so lucky and will need to self-teach. Typically, we see a sharp learning curve whereby vets who apply themselves quickly master the technical skill of scanning, and can repeatedly locate the more tricky anatomical areas such as the pyloroduodenal junction and the adrenals. However, over time their learning tends to plateau; they can now easily recognise abnormalities but may struggle to interpret them. This is where finding a mentor becomes even more important; you can double check yourself and the conclusions you are drawing from your scans, allowing you to keep growing and improving your knowledge. Put yourself in the best place you can, by gathering resources around you such as good quality ultrasound textbooks, attending webinars and courses, and reading articles relevant to your topic of interest.
Action: If you are not blessed with a mentor in practice, reach out to others in the veterinary community; specialist or special-interest colleagues, course teachers, clever friends, and when at a loss there are social media forums where vets can support each other around tricky cases. BUT, (as a friendly warning) in order to avoid irritating everyone who knows what they are doing with blurry phone videos and skewed photos of an ultrasound screen, ensure you are performing complete and systematic scans, learn the correct terminology to describe abnormalities that you see, and ensure your image optimisation skills are very good. By doing so you will be able to capture high quality stills and video clips, export the files, and upload or email them directly. Just like you wouldn’t refer a case without a history, be a professional when asking for assistance with your scans.
Although being confident and competent in ultrasound is the goal, it is important to add that just like every aspect of veterinary science, you need to recognise your own limitations. If you are out of your depth, please refer as appropriate! In fact, if you have scanned the patient yourself before referral, it provides a wonderful double-check mechanism and learning opportunity.
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