Echocardiography: a personal experience

IMG_4493 (Large)In clinical practice, cardiology is nowadays all about echocardiography. A physical examination, chest radiographs and an ECG will only get you so far. To make a definitive diagnosis, you need to be a master of echocardiography. And the best way to achieve that end is to do hands on training. Books will only get you half the way there; to get the whole way, you need one-on-one instruction with a gifted tutor using live animals.

The fastest way to make solid progress is to do basic course in echocardiography run by the CVE, and I recently enjoyed full weekend working with Niek Beijerink in Ross Pedrana’s practice in Dubbo. Ross kindly provided a venue, his own dogs and a range of canine patients with structural heart disease from his practice. John Marriot provided a range of up-to-date GE diagnostic ultrasound units, ultrasound cushions, ECG clips and abundant acoustic coupling gel. The whole weekend was devoted to teaching and learning, with equal emphasis on theory and practice. The first day was a “basic course” designed for people with limited experience with ultrasound. The second day was an “advanced course” for people who had some experience and expertise, but who wanted to take things “to the next level”.

Niek is a skilled presenter and a very effective communicator. The first day started with the theory of diagnostic ultrasound, explaining the physics that underpins the practice of echocardiography. This is hard to make exciting, but Niek drew pertinent examples form real life to explain why you need a certain transducer frequency to do one application, but another to do something else. This was a good talk to start the day with, as it was hard work, yet completely essential. He then moved on to how to drive the machine, and how to obtain standard right parasternal long and short axis views, the bread and butter of echocardiography. This was first done in a series of PowerPoint presentations, and then again in real time using a normal canine “volunteer”. The delegates then got about 90 minutes of hand on scanning, working in groups if two at 6 different workstations, with Niek, his Resident and myself (as adjunct tutors) working with the 12 people attending the workshop. As each of the dogs had different forms of heart disease, and different thoracic wall conformation (and hence acoustic windows), the delegates moved from workstation to workstation during the course of the day. After lunch, Niek continued with further didactic presentations on M-mode echocardiography and the finer points of measurement, skills mandatory for quantitative recording of echocardiography data. This was reinforced by further demonstrations by Niek and another 90 minutes of hand-on scanning. Finally, to finish the day Niek went through a series of clinical cases with the delegates. This was a full on day, and I was pretty shattered at the end of it (it’s a long day starting at 9 am and finishing at 5.30), but the people attending were satisfied and happy, and felt they had achieved a lot. This included people that already had some considerable experience in diagnostic ultrasound; they felt they had “broken through” and now could do things faster and more reliably than before, and with better insight and understanding. Continue reading Echocardiography: a personal experience