Oregon has become the second state to sign a sonographer licensure bill into law.  On July 28, 2009, Oregon Governor Ted Kulongoski signed the HB 2245 sonographer licensure bill.  The law renames and restructures the Oregon Board of Radiologic Technologists to the Oregon Board of Medical Imaging (OBMI) and ensures representation of sonographers on the Board. The sonographer licensure law requires Oregon sonographers to become licensed by OBMI effective July 1, 2010. Beginning on January 1, 2014, all sonography licensees would be required to hold a national sonography certification/credential (or be currently enrolled as a student).

ARDMS is expected to be an accepted credentialing organization that will fulfill the state licensure requirement.  With the dates already set in place, additional administrative rules/regulations will be developed over the next year.

The ARDMS Legislative and External Affairs Committee will continue to monitor the developments of the Oregon law and provide updates via the ARDMS website (www.ARDMS.org) and in future editions of Registry Reports and NewsWire.

Additional Online Resources Regarding the Oregon Sonographer Licensure Act:

HB 2245 Sonographer Licensure Bill (Oregon Government website)        
http://www.oregon.gov/RadTech/pdfs/hb2245c.pdf
                               
Oregon Governor Signs Sonographer Licensure Legislation (SDMS Website)
www.sdms.org

Recently, New Mexico became the first state to require licensure for Sonographers, below you will find some additional resources relating to the New Mexico bill.

Additional Online Resources Regarding the New Mexico Sonographer Licensure Act:
                               
New Mexico Medical Imaging and Radiation Therapy Health and Safety Act (New Mexico Legislature Website)            
http://legis.state.nm.us/Sessions/09%20Regular/final/HB0498.pdf
                               
New Mexico Sonographer Licensure Law Signed (SDMS Website)
www.sdms.org/news/newmexicoarticle.asp

Frequently Asked Questions: New Mexico Sonographer Licensure Law (SDMS Website)
www.sdms.org/news/NewMexicoFAQ.asp

What are your Thoughts on Licensure Programs for Sonographers?

ARDMS welcomes comments from Registrants and the sonography community about licensure programs for Sonographers. Please send an e-mail to communications@ARDMS.org and indicate “Licensure” in the subject line.

Outlook: Overall employment of diagnostic medical sonographers is expected to increase by about 19% from 2006 to 2016, which is faster than the average for all occupations.

Pay: The 610 diagnostic medical sonographers in the Seattle-Bellevue-Tacoma area earned a median wage of $77,510 in 2008.

Training/licensing: Sonographers may receive training in hospitals, vocational-technical institutions, colleges and universities.

Source: U.S. Bureau of Labor Statistics

View the article online.

Article written by staff at blog.marketplace.nwsources.com and adapted for the purposes of this newsletter.

Babies poised to enter the world feet first can pose serious complications for themselves and their moms.

Among single-baby pregnancies, just 3 percent to 5 percent are known as "breech presentations," with the baby's bottom, rather than head, positioned closest to the birth canal.

But though the numbers are small, experts say the risks can be big. Because of this, knowing about a breech presentation ahead of time can help the parents-to-be and their doctor decide what to do -- whether to try to rotate the baby in the womb or prepare for a Cesarean delivery.

"The trend is not to deliver breech vaginally," said Dr. Joshua Copel, a professor of obstetrics, gynecology and reproductive sciences at the Yale University School of Medicine. "Most breech [babies] get delivered by C-section."

With breech presentation, vaginal birth can be far more difficult. According to the American College of Obstetricians and Gynecologists, it can be difficult to guide the baby's head out of the mother's body last because the baby's body might not have stretched the cervix sufficiently. And a prolapsed cord -- when the umbilical cord slips into the birth canal before the baby, stopping the flow of blood to the baby -- is another increased risk in vaginal deliveries of breech babies.

The standard way to detect breech -- by feeling a woman's abdomen -- isn't foolproof. A BMJ study, in fact, reported that 30 percent of breech presentations were missed when this method was used. In some cases, that has prompted the addition of an ultrasound examination if a breech presentation is suspected.
"If I am uncertain about a baby's position by 33 or 34 weeks, I recommend an ultrasound," said Susan Moray, a certified professional midwife in Portland, Ore., and a spokeswoman for the Midwives Alliance of North America. "I think it's used more than in the past."

In fact, it can be overused, Moray said, citing a woman she knew who had 11 ultrasounds during her pregnancy.

But Copel and Moray agreed that ultrasound can be valuable in detecting breech babies. Once the ultrasound confirms a breech presentation, they explained, a technique called external cephalic version can be done. This involves external manipulation to turn the baby in the womb to a head-first position.

It's typically done at week 35 or 36. (A full-term pregnancy is about 40 weeks.) "Seventy percent of the time, it works," Copel said.The procedure typically is not done earlier, even if a baby's breech presentation has been confirmed. "I don't worry about breech presentation until the woman is getting close to 34 weeks," Moray said. "Babies often flip around," and the problem could correct itself, she explained.

Some evidence exists that breech presentations run in families or have a genetic link, according to another BMJ study, published last year. If one or both parents were born breech, it found, their children were twice as likely to be born that way, too.

And Moray said that she might pick up that information in her standard questioning of medical history. But Copel doesn't believe that such information is of much practical use.

Even with a woman who had no family history of breech presentations, he said, he still has to keep in mind the possibility that the baby could be feet-down in the womb.

If a baby is still feet-first near the due date, a C-section will probably be recommended, Copel said. But some women may be committed to a vaginal birth and ask if that's possible.

It could be, according to the American College of Obstetricians and Gynecologists, which issued a committee opinion on breech babies about three years ago. But the opinion stresses that great caution must be exercised if a breech baby is to be delivered vaginally and advises doctors to warn prospective parents of potential risks and have them sign a consent form saying that they're aware of the risks.

In a breech baby, according to the American Academy of Family Physicians, the infant's hip socket and thighbone are more likely to become separated during a vaginal delivery, and compression of the umbilical cord is also more likely, which can lead to brain damage from a lack of oxygen.

But Cesarean delivery is not risk-free either. Greater chances for bleeding and infection as well as longer hospital stays have been found for women who deliver by C-section.

View the article online.

Article written by staff at health.usnews.com and adapted for the purposes of this newsletter.

A team of researchers working at the MR-Center of the University Children's Hospital in Zürich has completed a pilot study using transcranial MR-guided focused ultrasound to treat 10 patients with neuropathic pain.

The origin of chronic pain in these patients included post amputation phantom limb syndrome, nerve injury, stroke, trigeminal neuralgia and post herpetic neuralgia from shingles.

The findings will be published in a forthcoming issue of Annals of Neurology.
“This study showed that we can perform successful operations in the depth of the brain without opening the cranium or physically penetrating the brain with medical tools, something that appeared to be unimaginable only a few years ago,” said Daniel Jeanmonod, M.D., a neurosurgeon at the University of Zurich.

“By eliminating any physical penetration into the brain, we hope to duplicate the therapeutic effects of invasive deep brain ablation without the side effects, and for a wider group of patients.”

The preliminary results in these patients are consistent with conventional therapy - radio frequency ablation - which is an invasive procedure and involves making an incision in the scalp, drilling a hole in the skull, inserting an electrode through normal brain tissue into the thalamus, and using radio frequency to create the lesion.

“This research demonstrates that transcranial MR-guided focused ultrasound can be used non-invasively to produce small thermal ablations with extreme precision and accuracy deep in the brain,” commented Neal Kassell, M.D., a neurosurgeon at the University of Virginia, and Chairman of the Focused Ultrasound Surgery Foundation. “It paves the way for further research into the treatment of a variety of other brain disorders, including Parkinson's disease and essential tremor, epilepsy, brain tumors and stroke,” according to Dr Kassell, the key advantage of focused ultrasound is that it is non-invasive. This in principle makes it safer than conventional surgery because it avoids the associated risks of complications such as infection, hemorrhage, and collateral damage to normal brain structures.

The study was partially funded by the Focused Ultrasound Surgery Foundation. The Foundation funds translational and clinical research into new therapeutic applications of MR-guided focused ultrasound (MRgFUS).

View the article online.

Article written by staff at sciencedaily.com and adapted for the purposes of this newsletter.

 

In an emergency department, time is of the essence. A quicker diagnosis can mean the difference between life and death, which is why physicians at Toronto East General Hospital (TEGH) are often now reaching for an ultrasound machine faster than a stethoscope and are national leaders in practicing this new technique.

Abdominal pain is the most common patient complaint in an emergency department, yet the underlying cause can range from indigestion to an aneurysm. Narrowing down a diagnosis is often a matter of elimination and thanks to ultrasound, many life-threatening complications can be diagnosed faster than ever before.

“Having the ability to use ultrasound in the emergency department is significant because it changes the way we are able to care for our patients,” said Dr. Paul Hannam, Chief of Emergency Medicine, TEGH. “There is better information available at the bedside. No single test is perfect, but using ultrasound adds another dimension to the clinical picture. In some cases, this can be lifesaving.”
The Canadian Emergency Ultrasound Society (CEUS) is the national organization that oversees emergency ultrasound training in the country and is comprised of physicians who promote the safe and effective use of ultrasound.

“The TEGH Emergency Department staff is among the leaders in emergency ultrasound in Canada,” said Dr. Peter Ross, President, CEUS. “All members of the department have taken a basic course in this subject. Much more importantly, they have nearly all gone on to be certified by the CEUS as Independent Practitioners. This is an extremely noteworthy achievement, as most emergency departments have no more than a few of its members certified to this level.”

The ultrasound machine, which is more compact than an average laptop, sits atop a metal trolley and can be easily maneuvered throughout the busy halls of the unit. TEGH, which began using the technology in 2007, has two devices, which physicians use multiple times during their shift.

The scanners are used to rule out possibilities so that physicians can guide the timing of a definitive scan in radiology. “We use the scanners to make sure there isn’t an immediate danger to our patient,” said Dr. Hannam. “A CT scan provides greater detail, but it can take a few hours to perform the scan and get the results back. Emergency ultrasound allows us to say yes or no right away. We still rely on our colleagues in radiology, but we can make decisions in the emergency room with more confidence.”

Emergency ultrasound focuses on the detection of certain urgent, life threatening conditions. For example, one patient walked into emergency and was complaining of pain in his abdomen and fainted. The physician, who would have previously sent the patient for a CT scan, used the ultrasound and saw a large aneurysm which was slowly leaking. A leaking aneurysm can become fatal within three hours without treatment. The patient, who wasn’t showing classic symptoms of an aneurysm, was immediately transferred to the operating room for surgery and was able to go home a week later.

“Ultrasound is transforming the way emergency medicine is practiced in Canada,” said Dr. Ross. “What makes the Canadian experience unique is the rigorously high standard with which ultrasound education has been disseminated across the country.”

Currently, there are 27 emergency physicians who have voluntarily completed the CEUS courses and can now call themselves Independent Practitioners at TEGH. Dr. Francis Sem, Ultrasound Education Coordinator at TEGH, has been the driving force behind much of this success. “The docs have really embraced this and all of us are doing it,” revealed Dr. Hannam. “This is most beneficial to the community as it’s rare to see such high and consistent standards with a new, non-mandatory practice. Emergency physicians like it because it works.”

View the article online.

Article written by staff at hospitalnews.com and adapted for the purposes of this newsletter.

Abnormal ultrasound findings after a transient ischemic attack may indicate high risk for future cardiovascular events, researchers found.

Blockages in cranial or extracranial vessels predicted more than a fourfold excess risk of stroke, Suwad Sadikovic, of the Technical University in Munich, Germany, and colleagues reported online in BMC Medical Imaging.
These results support routine imaging with both transcranial and extracranial Doppler in patients experiencing transient ischemic attacks, the researchers said.

Cranial ultrasound abnormalities also predicted an 18-fold excess risk of heart attack, suggesting these findings should spur consideration of routine screening tests for coronary artery disease and aggressive prevention therapies, they wrote.

Although patients who've had a transient ischemic attack are, overall, at elevated risk for second events, large-scale routine screening for coronary artery disease is not considered cost-effective, the researchers noted.

Rather, the guidance for clinicians has been just to "optimize" coronary evaluation for these patients based on individual cardiovascular risk profiles and the prevalence of carotid artery disease.

To see if imaging would be effective in determining especially high-risk patients in this population, Sadikovic's group studied 176 consecutive patients admitted to the stroke unit of a single center for transient ischemic attack -- defined as acute transient focal neurological deficit with complete reversal within 24 hours.
All were imaged with MRI and standardized extracranial and transcranial

Doppler at baseline and followed for subsequent vascular events over a median of 27 months.

Findings from these included:

• 47.7% had extracranial plaques without stenosis
• 19.3% had at least 50% cervical artery stenosis or occlusion
• 3.4% had high-grade cervical carotid stenosis of at least 80%
• 9.2% had intracranial stenosis

Even before the index transient ischemic attack, 23.1% of patients had had a prior ischemic stroke or transient ischemic attack, 5.1% within the month before admission.

During follow-up, too, cardiovascular events were common:

• 5.7% had a subsequent ischemic stroke
• 8.8%, another transient ischemic attack
• 5.7%, possible cerebral ischemia-related symptoms but did not seek medical attention or had competing differential diagnoses
• 1.8%, an MI
• 1.2%, an acute coronary syndrome
• 2.4%, a revascularization procedure for coronary artery disease
• 2.4%, a first-ever attack of angina
• 6.0%, other vascular events, such as deep vein thrombosis

Predictors of new cerebral ischemic events in the multivariate analysis included a 4.30-fold increased risk with pathological extracranial ultrasound findings and 4.73-fold increased risk with pathological transcranial ultrasound findings (both P=0.01).

For prediction of new cardiac ischemic events, abnormal transcranial ultrasound findings were associated with a hazard ratio of 18.51 in the multivariate analysis (P=0.001), whereas abnormal extracranial findings showed only a trend (HR 2.93, P=0.116).

"The association between transcranial Doppler findings and cardiovascular prognosis is of particular importance as cardiovascular disease becomes the major cause of death on long-term follow-up after transient ischemic attack," the researchers wrote.

For combined cerebral and cardiac ischemic events, revascularization, and death from vascular or unknown causes, both sets of pathological ultrasound findings remained significant predictors in the multivariate analysis (extracranial HR 3.46, P=0.02, and transcranial HR 4.97, P<0.001).

The investigators cautioned that their study may have been limited by largely self-reported events and lack of distinction between symptomatic and asymptomatic vascular disease.

Also, the definition of abnormal extracranial findings included both cervical internal carotid artery and cervical vertebral artery lesions, so "the results cannot be equated with the prognostic value of isolated extracranial carotid disease, which might be higher," they noted.

And since the definition of pathological transcranial Doppler findings included both reactive collateral blood flow secondary to extracranial lesions and intracranial stenosis or occlusion, the study likely picked up the group with the "highest risk of generalized atherosclerosis and, consequently, cardiovascular ischemic events."

View the article online.

Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter