Leading echo voices shared their top tips for trainees during this year’s conference in a session curated by Dr Richard Fisher, Consultant in Intensive Care Medicine at King's College Hospital. Dr Francisca Caetano, Dr Jonah Powell-Tuck, Ms Kelly Victor, Dr Claire Colebourn, Dr Peter Moran, and Dr Haten Soliman-Aboumarie, answered common questions and shared their experience.
Do you have any words of wisdom for trainees just starting out in echocardiography?
“It's all about time and practice. It's hard in the beginning, and you will feel that you will never be able to do it. But just keep practicing. Take every opportunity to just hold a probe and get some images,” said Dr Caetano.
How should trainees go about starting their training in focused echo?
Enrolling on a training course, such as Resuscitation Council UK’s one-day FEEL (Focused Echocardiography in Emergency Life Support) programme, is a good first step, said the panel.
How should trainees go about seeing as many studies as possible?
Events such as the level one case book session at the British Society of Echocardiography’s annual meeting, which is now available online, are a good opportunity to see images online, said Ms Victor, adding that there was also chances to review pictures within both focused imaging and general multidisciplinary teams. “Becoming familiar with what a normal scan looks like puts you in good stead to be able to recognise what's abnormal,” she said.
What should trainees do next?
“The best training ground is to echo with somebody who is good at echo. Ask them to correct your hand skills,” said Dr Colebourn.
Trainees should take their time when learning to echo, said Dr Powell-Tuck. It’s not about accumulating the requisite number of cases to meet the curriculum, it’s about building on your understanding of the physiology with each scan you complete, he said.
What are the key things to consider when you are getting ready to perform a scan?
Dr Moran said positioning was “without doubt the most important thing”.
The panel shared their top positioning tips:
- ideally, sonographers should ask patients to lie on as far over on the left lateral position (45 to 90 degrees) as the constraints of the clinical situation allows
- try putting a pillow behind their right shoulder
- try asking the patient to lie on their left side with their left hand behind their head
- move ECG dots if they are in the way
And once you’ve positioned the patient?
Choose a comfortable position for yourself, said the panel. Dr Moran said the sonographer should not have to reach for the buttons. “They should be very accessible so that it doesn't disrupt you when you have the perfect image.”
Can we start scanning yet?
In normal times, echocardiologists will also set up an ECG as it is “almost impossible” to assess some components without knowing when systole and diastole are happening, said Ms Victor. However, many centres are currently not using ECGs in this way, as part of their COVID infection-control measures.
How do you go about optimising your images?
Said Dr Colebourn: “Always optimise in the same order, because that will have the greatest effect on the image quality – depth first, width second, focus next, and then adjust the gain. Most frequently, you'll want to adjust the gain down, because you'll have too much grey in the blood pool.”
Any advice for when you just can’t get a good view?
The panel agreed that this was a particular problem at the moment, as more echoes were needed in intensive care patients. Make “maximum use” of the subcostal views in this situation, they said.
Is there any essential reading that should be done in parallel to practical scanning?
“Knowing your physics” is essential to quality echocardiography, said the panel. Physiology is equally important, they added, pointing to the heart-lung.org website which contains a series of short lectures on cardiovascular and respiratory physiology.
Any final words?
Said Dr Colebourn: “Think of a study as three parts: preparation, performance, and communication with the team regarding the input question. That is what a level one study is, and you should spend equal time perfecting all three parts.”
BSEcho 2020 presentations are available on our website for members of the Society.
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