Level Two
Ultrasound Intermediate
An intensive 2 day course intended to take a basic point of care ultrasound practitioner to the next level. The course covers 6 modalities, delivered through focused lectures and hands-on practical sessions. In addition, the candidates are exposed to several case studies intended to integrate ultrasound within a clinical context. Every day concludes with the candidates attempting to identify various pathologies on patients using the skills acquired throughout the sessions.
Guided by experienced physicians
Small groups and lots of scanning time
Delivered over a two day intensive course
Modalities Covered
Evaluation of the heart and valves at an Intermediate Level, taking Level 1 ECHO to the next stage. After this session the candidates will be able to:
• Acquire the Apical 4 and 5 chamber view
• Measure the Ejection Fraction of the LV using Teicholz Formula and Fractional Shortening
• Identify areas of regional wall motion abnormality in the LV secondary to Acute Coronary Syndrome
• Grade LV hypertrophy by measuring the interventricular septum
• Recognise HOCM and Apical Cardiomyopathy
• Evaluate the Valves for morphological abnormality
• Identify and grade valvular regurgitation using Colour Doppler
• Identify features of raised pulmonary pressure suggestive of PE (in the right clinical context)
• Assess a pericardial effusion for features of tamponade
The didactic component is followed by a practical hands-on session. In addition candidates go through a series of case studies to consolidate the recognition of pathology and the integration of the skill into a clinical context.
Evaluation of the lung with US for the identification of important pathologies including pneumonia, pneumothorax, pleural effusions, pulmonary oedema and ARDS/pneumonitis. After this session the candidates will be able to:
• Appreciate the evidence base for lung US in various conditions
• Understand the principles of lung ultrasound
• Select the correct probes and settings to maximise diagnosis
• Perform a 12 zone US protocol to evaluate the lungs
• Recognise the appearance of normal lung
• Utilise a diagnostic scanning approach to evaluate the lung and identify pathology in the various zones
The didactic component is followed by a hands-on session to allow the candidates to gain confidence with the scanning technique. This is followed by a discussion of case studies to improve visual recognition of the various pathologies and integration of the findings into a clinical context.
Evaluation of the proximal deep veins of the lower limbs for the presence of thrombosis. After this session candidates will be able to:
• Appreciate and understand the evidence base and principles of compression ultrasound for the diagnosis of DVT
• Identify and scan the proximal deep veins of the lower limb
• Diagnose DVT
• Identify features of acute vs chronic DVT
• Recognise alternative diagnosis for pain and swelling in the lower limb such as cellulitis or Baker’s cyst
• Integrate DVT scanning into a clinical algorithm
• Appreciate the limitations of the scan
The didactic component is followed by a practical session to gain confidence with the identification of the lower limb veins and the scanning technique to diagnose DVT.
Evaluation of the Hepatobiliary system including the liver, gallbladder, pancreas and ducts. After this session the candidates will be able to:
• Identify the structures of the hepatobiliary system
• Utilise a systematic approach to evaluate the liver
• Recognise and differentiate simple hepatic cysts and haemangiomas from tumours
• Evaluate the liver for intrahepatic duct dilatation
• Identify and measure the common bile duct to confirm obstruction
• Visualise the GB using different approaches
• Identify GB pathology including calculi, sludge, polyps and cholecystitis
• Visualise the pancreas and identify tumours
• Use a structured approach to evaluating bile duct obstruction
The didactic component is followed by a practical hands-on session. In addition candidates go through a series of case studies to consolidate the recognition of pathology and the integration of the skill into a clinical context.
Evaluation of the renal system including the kidneys, ureters and bladder. After this session the candidates will be able to:
• Identify the structures of the renal system
• Utilise a structured approach to evaluate the kidney
• Identify normal renal variants
• Recognise and differentiate simple cysts from complex cysts and tumours
• Detect renal calculi and apply scanning tips to improve visualisation
• Diagnose and grade the severity of hydronephrosis
• Identify ureteric and vesico-ureteric calculi
• Measure the bladder and calculate the bladder volume to evaluate urinary residual
• Recognise and differentiate bladder calculi and tumours from haematomas and sediment
• Identify bladder diverticula
The didactic component is followed by a practical hands-on session. In addition candidates go through a series of case studies to consolidate the recognition of pathology and the integration of the skill into a clinical context.
Focused evaluation of aspects of the MSK system and soft tissues for specific pathology. After this session the candidates will be able to:
• Perform a focused assessment of the paediatric hip joint and identify an effusion
• Diagnose sternal fractures
• Evaluate the ribs for fractures and detect intercostal muscle contusion
• Diagnose paediatric skull fractures and differentiate them from normal sutures
• Identify tears and hematomas in the calf muscles
• Recognise a lipoma
• Recognise and evaluate a lymph node
• Diagnose and differentiate abscess from cellulitis
The didactic component is followed by a practical hands-on session.