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ARDMS Examination Development
A brief overview of the multi-year process it takes to bring a new ARDMS examination to the Sonography community...

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Headlines in the News:

Role-playing Helps Radiologists Convey News About Fetal Abnormalities

Structured role-playing aids radiologists in conveying news about fetal abnormalities to expecting mothers....

Ultrasound Speeds Up Biodiesel Production

The same technology used to image fetuses in the womb could lower the cost of biofuels...

Guided Ultrasound for Noninvasive Skin Tightening May Be Wave of Future

A new technique using "guided" ultrasound shows much promise as a future noninvasive skin-tightening approach...

ARDMS Examination Development

A brief overview of the multi-year process it takes to bring a new ARDMS examination to the Sonography community...

One of the most labor intensive and rigorous activities at ARDMS is the development of a new exam.  Below is a brief overview of the multi-year process it takes to bring a new ARDMS examination to the Sonography community.

ARDMS Examination Development Steps:

1. Topic Proposed: The new examination topic is identified by ARDMS based on trends/advancements in sonography or recommendations through formal petitions by an organization (s) or groups of medical professionals.

2. Needs Analysis Study: A study is conducted to determine if a need exists for the new examination or credential.

3. Recommendation & Approval: Based on the results of the needs analysis study, the Examination Development Committee recommends the new examination to the Board of Directors for development approval.

4. Examination Development Task Force (EDTF): Sonographers and physicians, knowledgeable in the subject area of the new examination, are initially appointed by the ARDMS Board of Directors. EDTF members are instrumental in the development, review, and editing of test content and questions.

5. Job Task Analysis (JTA): EDTF members develop an extensive and detailed JTA survey that is sent to a representative sample of appropriate medical professionals to determine the frequency and importance of tasks performed for a particular sonography discipline.

6. Exam Content Outline Development: Based largely on the results of the Job Task Analysis, the EDTF members develop a content outline for the new examination.

7. Item (Question) Development: Using the content outline as a guide, item writers draft items (questions) for the new examination. Item Reviewers then review, edit and determine which items will be included on the pilot version of the examination.

8. Piloting the Exam: A pilot version of the new examination is administered in proctored testing centers over a specified period. Pilot participants are not provided with their score upon completion of the pilot exam.

9. Standard Setting Study: EDTF members and other subject matter experts review the results of the pilot test to determine the passing standard/passing scores. Once the passing standard is determined, test takers from the pilot test are sent their examination score.

10. Development of the Final Forms: Based on the results of the pilot test and standard setting study, the EDTF members assemble the final forms (or versions) of the new examination.

11. Launching the New Exam: Like all existing ARDMS tests, the new examination is administered in proctored testing centers in the US, Canada and select international sites.

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Role-playing Helps Radiologists Convey News About Fetal Abnormalities

Structured role-playing aids radiologists in conveying news about fetal abnormalities to expecting mothers....

Advanced ultrasound and MRI procedures are making it easier for radiologists to identify fetal abnormalities. But telling a pregnant woman the news, often early in a pregnancy, is increasingly becoming the responsibility of pediatric radiologists, who are assuming roles as front-line physicians.

Unfortunately, few radiologists are trained in professional communication skills. However, with the advancements in fetal imaging, these skills are needed to help an expectant mother and her spouse or partner understand what they should know to manage a pregnancy when a fetus is abnormal.

The process isn't intuitive, according to Dr. Stephen Brown, a pediatric imaging and intervention specialist at Children's Hospital Boston, who discussed the topic with attendees at the Society for Pediatric Radiology (SPR) annual meeting being held April 13-17.

Brown recommended structured role-playing with a multidisciplinary team including professional family and patient representatives or professional counselors. The role-playing sessions should incorporate formal critiques and evaluations. Using an instructional video, he demonstrated how a well-meaning physician's clinical terminology-filled explanation of spina bifida confused and angered a young woman in her first trimester of pregnancy. Nothing was incorrect about the physician's explanation, but nothing was right about it either.

"The experience of presenting new, complex, and often difficult information is familiar to all of you in this room," he said. "As pediatric radiologists, you probably are experienced in talking with parents about an unexpected life-threatening diagnosis of their child. But the treatment options and the outcomes may be known and clearly defined. This is not the situation with many fetal abnormalities."

"A substantial gap exists between what we can image and what we can reliably know or extrapolate about the future child's capabilities," he explained. "This gap and other distinctive clinical features of prenatal care in the setting of a fetal abnormality make discussing difficult and unexpected information particularly challenging."

Brown told attendees that the prospect of talking about fetal abnormalities causes stress, which can linger after the meeting with the pregnant patient, no matter how many times the radiologist has experienced it. When discussing a fetal abnormality, radiologists worry that they will say the wrong thing, their remarks will cause pain, they may put themselves in medicolegal jeopardy, they don't have enough time, or the setting where the discussion takes place is inappropriate or distracting.

Radiologists need to prepare themselves in advance to know what information they wish to convey based upon what the patient needs to know, wants to know, and does not want to know, Brown counseled. He pointed out that some patients do not want to know a lot of details, and radiologists should respect this.

Brown recommended that radiologists acknowledge the stressfulness of the situation and acknowledge their emotions at the outset of a meeting. Being respectful, compassionate, humble, empathetic, and sensitive may help reduce or allay a patient's fears and anxieties, he said.

He offered a tip that he'd received from a pediatrician, who said a mentor told him at the beginning of his career to conspicuously take off his watch in front of the family members when going into a conference with them. "Now he takes off his watch and his pager, and turns off his cell phone and PDA," Brown said. "But the message is: 'Stop. Be quiet. Listen. Let's talk.' "

A two-way conversation is needed, and patients should be encouraged to express their feelings openly. The radiologist should assist the patient in articulating and prioritizing concerns and fears. Brown suggested identifying prior to the meeting the steps for all available options, as well as the medical professionals and support resources the patient may wish to consult.

Dealing with a fetal abnormality may entail terminating a pregnancy. Brown warned that physicians' own moral or religious convictions may affect what they say, and this bias may inappropriately affect patients. Training in formal communications and role-play may make radiologists aware of remarks that others consider biased.

Brown asked rhetorically: Should a radiologist share with the patient his or her own personal beliefs? Maybe. Maybe not. He had no answer. "There is an absence of standards on what information should be imparted," he said. "We are left to our own judgment, experience, and biases when we engage in these complex conversations with pregnant patients and their partners."

View the article online

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

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Ultrasound Speeds Up Biodiesel Production

The same technology used to image fetuses in the womb could lower the cost of biofuels..

Biofuels are an increasingly admired source of alternative energy in times of unstable gas prices.

Production of biofuels, however, is quite slow -- about an hour to produce a few hundred milliliters in a laboratory, which is not efficient, especially when demand is high. That is why researchers at University of Missouri’s Agricultural Engineering department are working on a unique way to speed up the production process to mere minutes, allowing supply to meet that high demand.

Ultrasound Speeds up Biodiesel Production

When gas prices skyrocket, people look to alternatives that will get them off oil. Biofuels, fuels made from biological sources such as plants, vegetables and even algae, are one such option. Making a biofuel is a complicated and time-consuming process that ultimately drives up the costs. Assistant Professor Bulent Koc of the University of Missouri may have a solution. He’s investigating how ultrasound technology, the same kind used to image fetuses in a mother’s womb, can speed up biofuel production. If it works, it could lead to higher supply in the marketplace at a potentially lower cost.

The conventional process of making a biofuel involves mixing the oil derived from the plant with an alcohol, usually methanol. During mixing, the alcohol reacts chemically with the oil, stripping away fatty acids that make the oil too thick for use in a fuel tank as is. The mixing process usually takes an hour to produce just a few hundred milliliters of biofuel because the mixers are not very efficient.

Koc, an agricultural and biological engineer, had used ultrasound technology as part of his research in the past to look at different properties of food. For example, he figured out concentrations of alcohol in wine by measuring the velocity of the sound waves within the wine and how long they took to bounce back. When he came to the University of Missouri, the agricultural engineering department required him to focus on energy rather than food, so he applied it to biofuel production.

The ultrasonic wave process works like this: a desktop computer-sized device, known as an ultrasound generator, drives an ultrasound transducer, the machine that makes ultrasonic waves pass through a mixture of methanol and vegetable oil. These waves heat the mixture of oil and alcohol, creating bubbles that eventually burst. The bursts release high pressure and temperature, which break the molecular bonds in the fluids, allowing the two liquids to mix at a much faster pace. After the molecular bonds break, the fatty acids release, producing the by-product glycerin, and the remaining molecules recombine into a biodiesel.

“We wanted to see the effects of ultrasonic energy on glycerin separation time, that means reducing the production time of biodiesel." Unlike the conventional process that takes an hour to produce a few milliliters, this process takes just five minutes to make about the same amount.

Leon Schumacher, a collaborative researcher who has worked with biofuels since the early 90’s and is the department head of Agricultural Engineering at the University of Missouri, believes one of the main problems of biodiesel production is its cost. He’s hoping that the use of ultrasonic waves can help make biodiesel cheaper for both consumers and producers.

“It does cost money to convert to a biodiesel. It’s not a free process, and the end result is that if we can minimize that, that would be a huge win for the biodiesel industry.”

Koc has used the technique on different vegetable and cooking oils, including soybean, sesame, peanut, and canola oils, with notable success. The main challenge with using ultrasonic waves, however, is that the machine transmitting the waves heats up quickly and can become damaged. Koc thinks this problem could be fixed with a machine that circulates a cooling liquid around the ultrasonic device.

“You would have a cooling jacket around the ultrasonic transducer. This way you could maintain the temperature of the device itself so that it doesn’t overheat or get damaged.” Koc has not yet made the cooling device. Currently, Koc and Schumacher are testing the ultrasonic biodiesels in diesel engines.

View the article online

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

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Guided Ultrasound for Noninvasive Skin Tightening May Be Wave of Future

A new technique using "guided" ultrasound shows much promise as a future noninvasive skin-tightening approach...

Skin-rejuvenation modalities such as lasers and radiofrequency (RF) are commonly used for noninvasive skin tightening. However, significant cosmetic results are still lacking.

Although it’s in its early stages of development, a new technique using “guided” ultrasound shows much promise as a future noninvasive skin-tightening approach.

“Ultrasound technology used for skin tightening is still in its fledgling stages and there is still significant room for improvement and development of the technology for this indication. However, there are intrinsic elements of ultrasound technology that render it particularly appropriate for skin tightening, and therefore, this treatment modality could eventually pan out to be very effective here,” said Murad Alam, M.D., associate professor of dermatology, otolaryngology and surgery and chief of cutaneous and aesthetic surgery, Feinberg School of Medicine, Northwestern University, Chicago.

Ultrasound can be delivered arbitrarily deep into the skin and subcutaneous tissue and can reach target areas without causing any significant injury to the surface of the skin, unlike other forms of energy used in dermatology. These include lasers, particularly infrared devices ranging from 1,100 nm to 1,800 nm, as well as mono-, bi- and unipolar RF devices.

With further evolution and development of ultrasound technology, “guided” ultrasound treatments could better differentiate and more precisely target specific structures in the dermis and subcutaneous tissue, resulting in more consistent treatments with more predictable cosmetic outcomes.

Ultrasound Study

The Ulthera System (Ulthera) is a noninvasive ultrasound device designed for full-face and neck skin-tightening treatments and is currently the only device of its kind approved by the FDA for a lift indication. Recently, Dr. Alam conducted a study evaluating the efficacy of the Ulthera device for brow lifting in the context of a procedure treating the full face and neck.

The study assessment included 35 patients who received a single Ulthera treatment to the forehead, temples, cheeks, submental region and side of the neck using varying ultrasound probes at different depths.

Results showed that 30 of 35 patients (86 percent) demonstrated a clinically significant brow lift three months after treatment. Compared to baseline, 83 percent of patients could achieve an average brow height elevation ranging from 1.7 mm to 1.9 mm lasting three month post-treatment.

Adverse events following the treatment were minimal and included slight erythema and edema which resolved in 78 percent of patients by day-two follow-up visit and in all patients by day-seven post-treatment.

“Focused ultrasound has been shown to cause some tightening of the facial skin such as the jowls, lower face as well as brow elevation. Theoretically, as the technology is optimized and as deeper and more sophisticated probes are developed, the focused ultrasound should be able to extend those results further without causing associated adverse events of current treatment modalities,” Dr. Alam said.

Skin tightening is believed to be associated with contraction of the fibrous septae that engulf the fat cells in the deep subcutaneous tissue. When performing a facelift, the SMAS, which lies below the level of the fibrous septae and the subcutaneous tissue, is plicated, resulting in a lifting effect of the sagging facial skin. Thermal energy in the form of ultrasound delivered to the SMAS could potentially also effect a contraction of these tissues.

“Heat delivered to the SMAS might cause some thermal contraction analogous to the kind of plicating achieved in a traditional facelift, which may result in a corresponding improvement in the facial contour. Focused ultrasound has a realistic potential to accomplish this task,” Dr. Alam explains.

Reliability, predictability

According to Dr. Alam, the problem and frustration seen with current skin-tightening techniques is that they are not always reliable, and predictable and reproducible cosmetic outcomes remain elusive. Moreover and for reasons that are still unclear, tightening is not equally effective in every patient or at every targeted site, resulting in variable outcomes.

“The Ulthera device has not solved these problems just yet, however, if the technology can be precisely tuned and approximate a noninvasive facelift, then the results might be more consistent as they are in a facelift,” Dr. Alam said.

One major advantage of the Ulthera device used for skin tightening is that it is not only therapeutic, but also a diagnostic ultrasound device. Unlike with most lasers and RF devices, the physician can visualize the layers of the skin and the target tissues with ultrasound before firing the device, making it a guided ultrasound.

Key developments that this novel technology would have to undergo could include the development of various probes of different depths and sizes and varying energies. These more sophisticated probes would allow physicians to apply ultrasound energy at different levels in the skin and subcutis and achieve more reliable and consistent cosmetic results.

According to Dr. Alam, skin tightening is difficult to do, substantiate and reproduce, moreso than any other dermatologic cosmetic intervention, and innovative tools like the Ulthera device may help dermatologists improve current cosmetic outcomes in skin tightening.

View the article online

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

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