The potential for ultrasound screening
Larger vet hospitals are beginning to look into the potentials of portable ultrasound as a screening tool, in the hands of their non-specialist vets or even their vet nurses. For smaller practices though, budgets either do not allow for the introduction of ultrasound equipment, or if there is a machine, only one or two vets know how to use it. The vision of portable ultrasound as the modern-day stethoscope has certainly not yet been realised in the veterinary world.
In the human realm, this has become a reality in a number of emergency departments in the UK, as well as in other countries. In addition, many wards will now have a portable ultrasound machine on site for registrars to pick up and use, particularly on out-of-hours cases where sonographers may not be available. The scans performed in this context are not formally reported, and there is no requirement for the user to be an accredited sonographer – it’s simply an additional tool to help triage patients, and the ability to identify an acute pathology without having to wait for the imaging departments to be available can save lives.
Of course, all of this is done within a hospital setting, where consultants are always available to review urgent cases. This would be the equivalent of the vet hospital equipping its staff with portable ultrasound equipment. So what about for the smaller practice?
A structured approach
You will remember the importance of structuring your scan, particularly when you first began working with ultrasound. You may have been taught to look for the bladder first, and you’d set yourself a number of tasks or ‘landmarks,’ following a set plan every time. By now, you probably scan on autopilot, but those methodical steps you drilled into your head are still the foundation of your work.
A structured scanning approach is the only way to guarantee a safe and thorough job is performed every single time, and every professional sonographer – with one year of experience or with twenty-five – will work to set protocol, acquiring a standard set of images in a logical order. They may take additional images of certain features of interest, or to better investigate a particular pathology, but their protocol forms the framework around which every examination is built.
More and more studies are being published which demonstrate the success of various focused scanning protocols. A focused protocol refers to a very limited set of images, and is explained here. Usually, the task is to rule out a particular pathology (for example, screening for rheumatic heart disease in developing countries, or acute pathologies (e.g. pericardial effusion, aortic dissection) in the emergency situation). Even in the hands of non-specialists (i.e. not doctors, not sonographers), who undergo a short period of training or mentoring, images can be acquired which are suitable for interpretation by a consultant.
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