TECHNICIANS' & DOCTORS' CERTIFICATION
COURSE
DETAILS & OUTLINE
The Institute for Spinal Ultrasound Imaging
John D. Reid D.C. (U.S. Patent holder for Spinal Nerve Root Imaging with ultrasound)
E-mail soniclin@aol.com tele: Data Center: 507-477-2277,
Many machine systems are all covered from American to foreign imports--tell us what machine system you work with and your experience levels and the course will be flexi-designed to meet your needs.
The course work is held in Rochester Minnesota the home of the famous Mayo clinic (no association with the institute) and there are ample accomodations easily available from King's suites for foreign or local Royalty to very reasonable basic rooms with ultra-modern safe security systems at all accomodations. Rochester is however rated as #1 in the USA for lifestyle quality and is famous for extremely low crime rates so you and your associates or family can relax in a low stress beautiful American City. During and after seminar times Rochester offers many entertainment facilities, PLUS the Mall of America is only 70 miles away. More locally many malls and Shopping Centers offer hours of fun, with a huge Cabela's outdoor store and an American History Center only 35 miles away in Owatonna Minnesota for those who enjoy camping and the outdoor life.
After the trainees return home the mail in of three patients sets of ultrasound images one set per time is required over a three week period of time. Training interpretations are charged pre-paid $75. per region for each of the three sets.* When clinical efficacy has been demonstrated on the long distance independent images mailed in for review and critiques, a beautiful certificate is issued for proficiency rating as from the United States Patent holder & the Institute for Spinal Ultrasound Imaging. Certified examiners are then entered in the ISUI Log book for future lego medical reference by inquiring parties. (Note* Usual interpretation fees are lower than training interpretation fees if a clinic desires long term interpretation services)
SECTION ONE: COURSE FOR TECHNICAL CERTIFICATION
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Note:* The sections of the course may be modified or emphasized depending upon the student's pre- knowledge and/or experience: classes are composed as much as possible of small groups of students with approximately the same levels of pre-course knowledge.
I. Introduction & History of the Ultrasound Scanning science
II. Introduction & History of the Orthopedic/Spine Ultrasound Scanning science
III. Basic Physics of sound waves/ Physiology & Safety.
A. SAFETY OF MACHINE FOR SPINE
1. PHYSICS
a. Energy
b. Interfaces & echogenicity verses absorption
2. PHYSIOLOGY
a. ABSORPTION BY THE PERIOSTIUM,
b. THE Correct Techniques for EXPOSURE
3. MACHINE SETTINGS:
1. Basic controls for any/all machines:
2. Gamma settings,
3. gain,
4. contrast,
6. transducers, types & utilizations
7. the good the bad and the ugly:
B. Machine types & specifics:
1. Hospital units,
2. Portable units
3. (Shimadzu, Medison, Hitachi, Pie Med., CST, Fukuda Densi -as applicable)
C. WIRE HOOK UPS
1. TRANSDUCER
2. POWER SUPPLY CORD
3. VIDEO HOOK UP
4. ON/OFF SWITCH
5. IMPORTANCE OF FAN
a. LISTEN
b. CLEARANCE FOR VENTILATION
D. Extreme safety notes/
1. power supply polarity,
2. static discharge dangers,
3. high rise buildings & oddities) POSITIVE GROUND WIRE
IV. PROPER PALPATION
A. LANDMARKS
THE CORRECT LEVEL IS AS IMPORTANT AS GOOD PICTURES
1. LUMBAR
L4 CREST OF HIPS TO CENTER THUMB TECHNIQUES
2. THORACIC
T1 BASE OF NECK AT TRAPS (STAT VERTEBRA)
3. CERVICAL C1/C7 BASE OF NECK (MOV VERTEBRA)
4. TRAPEZIUS
5. SACROILIAC
6. GLUTEALS AND SCIATIC NOTCH
7. HIPS
B. MENTALLY IMAGING THE DEEP ANATOMY
1. Lumbar ideal: The King (The outline of a typical Lumbar vertebra resembles a King's piece in the game of chess, thus chess set analogies are extremely helpful in simplifying the teaching:)
2. Thoracic ideal: The King's Landscapes
3. Cervical Three ideals: The Princes:
4. ANGLES OF INCIDENCE AND ANATOMY INTERACTION
5. FREQUENCIES AND SIZE OF PARTS
6. FREQUENCIES AND PATHOLOGY
7. EXAMPLES of Technique and pathology alterations and artifacts
a. Angular MYOSITIS SHIFT
b. Gain/Gamma SPASMS SHIFT
c. Gain/Gamma THE CASTLE SIGN SHIFT
C. MNEMONICS REVIEW
a. THE KING
b. THE KNIGHT
c. THE BISHOP
d. CASTLE REVISITED
e. ANGEL WINGS SIGN
V. The Book of Pathological Kings
VI. The Book of Normal & Pathological Extremities
VII. Tomographic Anatomy Book Reviewed
VIII. ACTUALLY DOING THE SCANS
A. PROTOCOLS & STANDARDS
1. TRANSVERSE TECHNIQUES ceph/caud universal Landmarks
2. Longitudinal Techniques bilat sequencing
3. Dynamic Techniques degrees range stepping
4. Bilateral views when needed
B. PATIENT EDUCATION (per discretion-per availability screens)
1. PATIENT PREPARATION
a. MENTAL
b. PHYSICAL
C. ETHICAL BOUNDERIES
1. Doctors orders
2. Technicians responsibility to discretely over-ride if necessary
3. MINIMAL DISROBING
4. TABLE SIDE MANNERS
D. Patient Technician Environment Interactive SAFETY PARAMETERS
1. SIGN OF A POTENTIAL PROBLEM AND SOLUTIONS
2. PATIENT DISTRESSED
a. HALT SCAN IMMEDIATELY?
3. MACHINE MALFUNCTION
a. HALT SCAN IMMEDIATELY?
E. ANATOMICAL LIMITATIONS (Adipose, Frequency Verses Gain, Interposed oddities, Interposed spasms)
F. MANUAL METHODS THEORY
1. ASPECTS AND ANGLES
a. CERVICAL
b. THORACIC
c. LUMBAR
2. SEE SAW AND WIGGLES
3. DOING SHIFTS AND COMPOUND IMAGES
4. PICTURE TAKING
G. MACHINE SYSTEMS CARE AND COMPONENTS
1. APPEARANCE
2. EQUIPMENT HANDLING
3. STORAGE
4. TEMPERATURE CHANGE environments & acclimation
5. THERMAL PAPER CARE
6. VIDEO TAPE CARE
H. Now with Knowledge of the goals, SCANNER REVIEW
1.. BRIGHTNESS
2.. CONTRAST
3.. NEAR GAIN
4.. TOTAL GAIN
5.. FAR GAIN
6.. Gamma settings, Frequency requirements
a. for Orthopedic extremity use/
b. for Spine use/
c. for Visceral employ
d. Principles of ultrasound as ultrasound for echogenic character
( simplex macro differentials spine mixed environment)
e. Principles of ultrasound as energy for anatomic relationships
(complex subtle differentials of visceral soft homog. environment)
I. TRANSDUCER
1. PLACEMENT FOR:
a. TRANSPORTING
b. IN USE
1. Set-up,
2. the wiggle VVV,
3. the wobble XX,
4. the hippy hippy shake < - >,
5. the nose, the tail,
6. bubbles,
7. oil, herbs and lathers (Could a massag/natural health person as a patient kill your machine system? - -what to watch for to avoid disaster! A little known danger which could cost you thousands of dollars in repair or replacement costs! )
J. THE PRINTER (an image factory in a box)
1. CONTRAST
2. BRIGHTNESS
3. THRU-(ON)
4. EE-(OFF)
5. POSI-(ON)
6. NEG-(OFF)
7. COPY-(REPRINT)
8. PRINT-(NEW PICTURES)
9. ON/OFF-(POWER)
10. PAPER REFILL-(RELOAD OF THERMAL PAPER) (How NOT to kill your printer instantly!) Also paper grades and implications.
K. Poisiology = POSITIONING RELATIVE TO PATIENT
1. WALKWAYS
2. WORK TABLE
a. PNUEMATIC TABLE CONTROLS
b. SPRING LOADED TABLE CONTROLS
L. MANUAL METHODS LAB
1. SCREEN (s) PREPARATION & PRINTER HARMONY
2. PROGRAM PREPARATION
3. ACCESSORIES FOR SCAN
a. LANYARD
b. PAPER TOWELS
c. Toy CARS (Why these little babies are a big KEY to success in any clinic or any mobile service!)
d. HAIR CLIPS
e. PENS
1. RED
2. BALLPOINT (BLACK)
f. ULTRA SOUND GEL
1. PROPER TEMPERATURE
2. PROPER DENSITY VISCOSITY
M. MANUAL METHODS OF IMAGING (EXAMPLES)
1. GOOD PICTURES (palpation aspects and angles review)
2. LUMBARS AND ACTUAL LAB
3. THORAX AND ACTUAL LAB
4. CERVICAL AND ACTUAL LAB
5. TRAPEZIUS AND ACTUAL LAB
6. SACROILIACS AND ACTUAL LAB
7. GLUTEALS AND SCIATIC NOTCH
8. HIPS AND ACTUAL LAB (Those tricky hip techniques---Got hips?)
9. SHOULDERS STATIC, DYNAMIC, DETAILED TECHNIQUES
10. HU INCH CONVENTIONS
11. Sterno-costal scanning for seat belt injuries:
l2. Wrist & Carpal tunnel (safe set-up ----effective scanning/frequencies)
13. Mystery Case upper extremity techniques----non carpal , carpal symptoms
14. Mystery Case lowr extrem. techniques---non sciatic sciatic/ paresthesias
15. Global thinking potentials for success in diagnosis
N. Break for questions and discussions
O. Lego-Medical PROCEDURES AND FORMATS
1. PATIENT FOLDERS
a. EXPLANATION OF FORMS
1. EMPHASIS ON
a. PATIENT HISTORY
b. TRAUMA (AUTO OR GENERAL)
c. PAIN HISTORY
d. AUTHORIZATION
e. LEIN FORMS
b. PROPER MARKINGS
1. FRONT LABEL
a. LAST NAME FIRST
2. INSIDE LABEL
a. PATIENT NECK MEASUREMENT (IF CERVICAL DONE)
b. AREAS SCANNED
c. PERTINENT INFORMATION
1. PREVIOUS INJURY OR CONDITION
2. PREVIOUS SURGERY
3. TRAUMA TO SCANNED REGIONS
4. ANY PRESENT UNUSUAL Medical/ Physical/Chemical CONDITIONS (Are there drugs which can slaughter the exam efficacy?)
P. WRITTEN EXAM AND REVIEW AS NEEDED
a. RE-EXAM IF NECESSARY
P. LABORATORY PRACTICAL EXAMS
a. REVIEWS AS NECESSARY
b. RE-EXAM AS NECESSARY
Q. From home the following week or two three image sets sent in for critique
R. (If efficacy and added value demonstrated)
S. CERTIFICATION OF TECHNICAL EXPERTISE
a. SPINE SCAN
b. EXTREMITIES SCAN
Section Two:
STANDARDS OF CARE
AND PRINCIPLES OF INTERPRETATION
II-A General Principles of Interpretation:
1. PAIN VERSES INFLAMMATION
a. What is INFLAMMATION?
b. Genetic VARIATIONS foraminas/ nerve diameters, CANAL cushion thicknesses
2. DETERMINE OLD FROM NEW INJURY
3. DETERMINE LOW VEL FROM HIGH VEL TRAUMAS
II-B EXAMINING THE IMAGES with Mental Sequencing
1. The King's Sky
2. The King's throne
3. The King's attire
4. The King's Deep Sea
II-C Sign by sign significance of multiple signs & affected tissues conditions
II-D Regional or bilateral "Differentials" Logic Principle reviewed:
II-E The ADDED VALUE three part report STANDARD of CARE:
1. Social value FINDINGS (with standardization parameters as intro)
2. Personal value/opinion: INTERPRETATION/IMPRESSION
3. Clinical value CLINICAL IMPRESSION, Treatment Plan recommendations:
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