Post Graduate Certificate in Ultrasound for Internal Medicine
Over 3 semesters, the program covers the Fundamentals of Ultrasound scanning and 6 essential modalities encountered in Internal Medicine including:
- Core ECHO and IVC
- Intermediate ECHO
- Lung
- Focused Assessment for Free Fluid (FAFF)
- US guided Vascular Access and Interventional (USGVAI)
- Deep Vein Thrombosis (DVT)
Generic Information
• Limited to 10 candidates per course for effective mentorship
• Blend of online lectures/webinars and in-person practice
• Segmented online lectures aid self-paced learning
• Online portal for resources, mentor interaction, and submissions
• Each candidate is assigned an experienced mentor for year-long guidance
• Facilitation of access to practice machines
• 6-8 in-person intensive practice days per course
• Mandatory practice logbook with scans and pathologies
• Final exam with practical and theoretical elements for course completion.
Learning Outcomes
At the end of the course the candidate should be able to:
• Appreciate the fundamental physics principles relating to ultrasound including the piezoelectric effect, the factors that influence imaging as well as the recognition and differentiation of various artefacts
• Recognise the importance of frequency and the way it impacts probe selection and machine settings
• Understand and utilise the proper terms to annotate images and report scans
• Utilise the various functions on US machines to optimise the scan
• Hold and manipulate the probe effectively being mindful of ergonomics
• Recognise the value of the various cardiac views in evaluating different cardiac structures
• Define the sonoanatomy and recognise the cardiac structures in all cardiac views
• Understand the changes in the cardiac chambers and valves during the cardiac cycle
• Define the normal upper limits for diameters and ratio of the cardiac structures
• Define the normal parameters for LV contractility
• Acquire parasternal long and short axis, as well as subcostal views of the heart
• Utilise a structured approach to optimise the various cardiac views and recognise the impact of specific movements on the cardiac appearance
• Adopt the DEFG structured diagnostic approach to the evaluation of cardiac dimensions and function
• Diagnose dilated aorta in dissection, dilated LA and dilated cardiomyopathy
• Evaluate the systolic function/contractility to diagnose heart failure with reduced ejection fraction
• Identify pericardial effusions and recognise tamponade physiology
• Evidence base for IVC scanning
• Understand the impact of respiratory physiology on the IVC
• Identify and correctly measure the IVC
• Define the maximal diameter and collapsibility index of the IVC in normovolemia and hypovolemia
• Identify which patients will benefit from fluid administration in cases of hypotension and shock
• Clarify when to transition to inotropes in shock cases
• Recognise the limitations of IVC scanning and the impact of raised pulmonary pressures on its use
• Issue a report
• Perform the apical 4 and 2 chamber view
• Define the sonoanatomy and recognise the cardiac structures in these cardiac views
• Adopt the DEFG approach to further evaluate the cardiac structure and function
• Identify and grade left ventricular hypertrophy and recognise cardiomyopathy
• Identify anatomical features suggestive of diastolic dysfunction
• Use Fractional Shortening to estimate the systolic function
• Appreciate the vascular supply of the different regions of the myocardium
• Identify the different regions of the heart on the different views
• Identify regional wall motion abnormalities
• Appreciate the normal and abnormal sonoanatomy of cardiac valves
• Diagnose and grade specific valve pathology using colour flow doppler
• Evidence base for lung ultrasound
• Anatomy and sonoanatomy of the lung
• 12 zone evaluation of the lungs
• Use a structured approach for the evaluation of each lung zone
• Appreciate the sonographic appearances of various pathologies
• Integrate the findings with the clinical context to assist diagnosis
• Appreciate the anatomy and sonoanatomy of 4 anatomical spaces which will be interrogated for free fluid including the right and left pleural spaces, peritoneum and pericardium
• Evaluate the right and left pleural space, peritoneum and pericardium for the presence of free fluid using 4 views: right and left flank, suprapubic and subcostal
• Identify the presence of free fluid in these spaces to diagnose pleural and pericardial effusions as well as ascites
• Understand the indications, sensitivity and limitations of FAFF scanning
• Recognise when to refer for further imaging.
• Apply techniques to minimise operator variability and improve the comprehensiveness of the scan
• Issue a report
• Recognize the evidence base underpinning the use of US in interventional procedures vs a landmark approach
• Infection control measures and sterility
• Evaluate the venous anatomy of the upper limb venous system using ultrasound
• Assess vein suitability using the WASPS approach
• Differentiate veins, arteries, nerves, muscles and tendons
• Optimising probe alignment for intervention
• Utilise in-plane and out-of-plane approaches for guided vascular access and interventions such as aspiration
• Use ultrasound to confirm successful cannulation
• Define the lower limb venous anatomy
• Differentiate veins from arteries
• Recognise thrombus within the deep veins of the lower limb and differentiate it from other pathologies with a similar clinical presentation
• Understand how to integrate US scanning in the clinical algorithm for DVT
• Appreciate the limitations of US scanning for DVT and when to refer to radiology
• Perform an ultrasound scan of the lower limb to identify deep venous thrombosis in the proximal deep veins
• Recognise alternative pathologies presenting with LL pain including superficial thrombophlebitis, Baker’s cyst and muscular hematomas
• Issue a report