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June 22, 2012

ARDMS Updates and Headlines in the News:

Apply Today - ARDMS is Now Accepting Applications For the First Administration of the Registered in Musculoskeletal™ (RMSK™) sonography Credentialing Examination

ARDMS Releases the MSK Prerequisite for the Registered in Musculoskeletal™ (RMSK™) sonography Credentialing Examination (This link opens a PDF document. To download the latest version of Adobe Reader, click here)

Read the ARDMS MSK How to Apply Guide

ARDMS: Important Testing Center Update

Bedside Cardiac Ultrasound Could Be Taught During Residency

Three Dimensional (3D) Ultrasound: A Noninvasive Gingiva Assessment Tool

ARDMS: Important Testing Center Update

• At the test center, you must present two current, valid signature IDs, one of which must be a non-expired government-issued photo ID with your signature; see the accepted list of IDs here.
• The name on your application must EXACTLY MATCH the name on both current, valid signature IDs.
• Jane R. Doe and Jane Rachel Doe DO NOT EXACTLY MATCH.
• Failure to present two acceptable IDs will prevent your admission to the test center. If this happens, you will be marked absent and you will forfeit the entire examination fee and seat.
• If the names do not EXACTLY MATCH, update your ARDMS name of record. 

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Beside Cardiac Ultrasound Could Be Taught During Residency

Incorporating cardiovascular limited ultrasound exam (CLUE) training for bedside use into the internal medicine residency curriculum is feasible, report US researchers.

"Realizing the widespread potential of ultrasound-assisted physical examination requires the creation of an imaging protocol that can be successfully taught to all physicians within the confines of accredited medical education," said Bruce Kimura and colleagues from Scripps Mercy Hospital in San Diego, California.

They add that without such an approach, the potential exists for "excessive diversity in bedside ultrasound practice."

The program employed evidence-based techniques, set proficiency goals, and assessed residents' performance, while minimizing cost by using readily available institutional resources, says the team.

After implementation of CLUE training in their medical curriculum, including 12 monthly 1-hour lectures, once-weekly 1-hour bedside training sessions in an intensive care unit, and the requirement to image a minimum of 30 patients, residents undertook a clinical exercise (CEX) to rate them on image quality, specific knowledge, and diagnostic accuracy.

Kimura and team set a "passing threshold" of 80% and the mean image quality, knowledge, and accuracy scores were 83%, 91%, and 91%, respectively.

CLUE-CEX results did not exert a negative effect on the overall academic performance of the residency among residents, they remark, neither did they note any significant relationship between academic performance and CLUE capabilities.

Residents completed a postgraduation questionnaire that indicated they believed CLUE improved their bedside examination, and that they would use CLUE in the future if it was available.

Writing in the Journal of Hospital Medicine, Kimura et al noted that this type of cardiovascular examination is likely to "expand to a more advanced version or become a component of a full-body 'ultrasound-assisted physical.' "

They concluded that despite being subject to the biases of any subjective resident skill assessment, that CLUE-CEX "was easily accomplished using a single form and faculty member, and was an efficient tool for program feedback and development."

View the article online.

Article written by staff at news-medical.net. and adapted for the purposes of this newsletter.

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Three Dimensional (3D) Ultrasound: A Noninvasive Gingiva Assessment Tool

A team of engineers and clinical researchers from West Virginia University (WVU) and the University of Pittsburgh is making progress in their quest to develop a 3D ultrasound system for assessing gingival tissue and inflammation and diagnosing gingivitis.

While ultrasound is best known in dentistry for its scaling and surgical abilities, the WVU team has been studying the use of high-frequency ultrasound to construct 3D images of hard and soft tissues in the oral cavity. In previous research, they demonstrated the ability to construct 3D images of the mandible and surrounding tissues.

At the International Association for Dental Research (IADR) meeting in Brazil this week, they will present findings from a new study using this technology to assess gingival tissue.

"We are in the early stages of developing 3D ultrasound to measure tissue alterations in gingivitis," said Eros Chaves, DDS, MS, DMD, an associate professor at WVU who will be presenting the study at the IADR meeting on June 22. "We know that we can do it in vitro; for this study, we compared histologies with the ultrasound in vitro."

Clinical and research applications

Dr. Chaves and his colleagues collected in vitro ultrasound scans via a proprietary high-resolution system that uses a 55-MHz single-element transducer. Gingival tissue samples were immersed in water near the ultrasound transducer focus, and continuous acquisition with a 400-MHz data acquisition card was synchronized with a high-precision 2D positioning system to acquire measurements of the gingival tissue samples.

The researchers found that ultrasound scans for tissues with gingivitis exhibited higher values of integrated backscatter, time variance, time entropy, frequency integrated backscatter, wavelet root mean square value, and wavelet integrated backscatter than normal tissue samples or samples with mild gingivitis.

When they compared the ultrasound scans with the tissue histologies, both revealed similar changes in the tissue, the researchers noted.

These findings indicate that parametric ultrasound has the potential to be used for diagnosing gingivitis, the researchers concluded, although more research is needed to investigate the diagnostic value of ultrasound for clinical research and chairside use.

Before joining the faculty at WVU, Dr. Chaves was in private practice and also worked in product testing doing studies for some of the major toothbrush and toothpaste suppliers, he said. He sees a need for a better diagnostic tool for product testing.

"It was all based on subjective criteria of gingivitis and plaque," he said. "And knowing the cost of the examiners and the subjectivity, it felt like we needed a better tool. So we are trying to see if ultrasound, which has been demonstrated to be effective in soft tissue in other medical areas, could work in gingival tissue also. I see this more for the research field, but my partners see it more as a diagnostic tool that could be used in the dental office."

Ultrasound advantages

Ultrasound imaging offers several advantages over conventional imaging methods for assessing gingival tissue, according to Dr. Chaves. There is no exposure to ionizing radiation, it is potentially more accurate than manual probing, and it is noninvasive.

"In clinical diagnostics of gingivitis, you have to probe the gingival tissue, which is an irreversible index because when you touch the tissue, it changes," he said. "If it starts bleeding and you have second examiner, they will see something different. Ultrasound is noninvasive and reversible. It doesn't change anything."

In addition, ultrasound technology is getting increasingly sophisticated, Dr. Chaves noted.

"The waves are much higher intensity now, so you can scan the tissue much better," he said. "CT scans can give a 3D image of the mandible, and now ultrasound can do the same thing with sound waves instead of x-rays."

Even so, there is more work to be done. While they originally had to use the same kind of ultrasound machine that is used in obstetrics and other medical examinations, the researchers have been able to reduce the size of the ultrasound scanner so they can now do more precise intraoral imaging rather than extraoral. The next challenge will be to image more of the oral cavity during a scan, rather than just specific areas. This will enable them to then begin in vivo studies.

"At this point, we are really learning and developing," Dr. Chaves said. "Every time we learn that it is possible to do this, then we have to learn how to do it in the patient, then the entire mouth of the patient, then in a patient population, very fast. It is going to take some work and creativity to learn how to do this in the entire mouth of the patient, rather than just specific parts of the gingival tissue."

View the article online

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

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