Ultrasound Image Review pearls with Patrick Ockerse, MD.

Ultrasound Podcast

This week, we had the pleasure of sitting down with Patrick Ockerse, MD at Bendfest 2019, a 3 day ultrasound event in Bend, Oregon. Dr. Ockerse is the ultrasound director at the University of Utah in Salt Lake City, Utah and part of his job is to review ultrasound images performed in his emergency department. Mike was formerly the ultrasound director in Utah and Jacob has a very similar job as the ultrasound director at the University of Kentucky in Lexington, Ky. This week, we sit down and talk about the errors we most commonly see when performing our image review sessions. Here are some tips:

Basics:

• Depth – Make sure that the image you’re trying to see is as big as you can make it. Don’t have any wasted space in your clips or images.
• Gain – Make sure your image is bright enough. But don’t over gain!
• Exam type – If you’re doing a FAST exam, don’t scan in the “lung” setting.
• Video clips – Be conscientious of the clips and images you take. Focus on the thing you want to record and record a long enough clip of it, but also don’t record multiple clips of subpar exams.

Specific exams:

• DVT – Make sure that the vein you’re evaluating is actually a deep vein. Deep veins paired, while superficial veins may be solitary. Also, don’t confuse a lymph node for a DVT.
• FAST exam – Slow sweeps of the regions your evaluating. Fast sweeps can miss subtle fluid collections. Don’t forget to look at the inferior pole of the kidney/caudal tip of the liver interface on the right side. Be careful with the seminal vesicles in the pelvis.
• Intrauterine pregnancy (IUP) – Make sure that gestational sac is actually inside the uterus.
• Thorax – Make sure to look at the back of the thorax when evaluating your patient with suspected pneumonia
• Aorta vs IVC – To identify the IVC, first find the right atrium then look for the thing coming off of the right atrium. That’s your IVC. Know your left and your right. Most of the time, the IVC will be on the patient’s right. Also, put color flow on it. The less pulsatile one is the IVC.

General

• We do quality assurance (QA) to make sure that our ultrasound examinations are the best they can be. We should aim to give negative feedback privately and commend when we see excellence!