Ask for help – even when you’re not sure you need it

Ultrasound is not (yet) an exact science. Machine learning is helping to bring us closer to it, but even when this day comes – and it’s currently only in the research stages – it’s unlikely that the human component will ever be completely replaced in our lifetimes. There will always be exceptions to rules, and at the moment, only a human brain is capable of thinking around these instances.

Because ultrasound can be so subjective, it’s important that you are part of a supportive community that you can turn to when you feel stuck, or simply need confirmation of something that you already know. Scanning in isolation can be lonely, scary, and dangerous. Dangerous because, even with all the experience in the world, it’s so easy to slip into bad habits. The human mind has a fantastic ability to reinvent norms of behaviour; of all the habits which you know you have (and there must be many more you’re not even aware of!), how well can you pinpoint the exact moment of their formation? Unless you’re an extremely self-aware individual, probably not many.

As well as an animal scanner, I’m also a human echocardiographer. I must have scanned thousands of hearts by now. On Monday when I was scanning in the Echocardiography department, my mind suddenly had a moment of doubt over a measurement I’ve been performing several times a week for years: do I average several measurements, or do I just take the highest value?

Why did I have that moment of doubt? I was looking over an old video case the night before of a patient with a very irregular heart rhythm, in which instance one would average all of his measurements; perhaps this is what planted the seed of doubt. I’d also been reading a very interesting paper on the accuracy of a single measurement versus repeated measurements on a standard Colour Doppler method used for grading the severity of leaky heart valves. All of this would have got me thinking – or overthinking – about measurements I perform as second-nature.

There might not have even been a logical reason, though! Sometimes things we’ve done thousands of times before just have a temporary moment of malfunction. 9999 out of every 10,000 times I chew, I manage to do so without biting my own lip. I also manage to successfully navigate around my bed without smashing my toe into one of the legs for most months of the year. I can even drink water without choking myself with a high success rate. Every now and again, though, something I’ve done one way a countless number of times is done a different way. In the case of giving myself a mouth ulcer, a limp or almost drowning myself at the dinner table, the feedback is instant and the behaviour corrected. But what about when I am scanning?

Alone in that moment, I might have decided that it was correct to average my patient’s values. On my next patient after that, I’d again be faced with that choice, and recalling a recent memory where I’d averaged them, I may have done that again. Suddenly, my brain would have a new habit, a new normal.

Luckily for me, I work in a busy department, and all I needed to do was turn to my colleague beside me and ask “should I average this measurement?”, and be answered, without a moment’s pause or judgement, “always take the peak.” We talk to each other, reaffirm what we are doing and ask each other’s opinions constantly. Any good ultrasound department will do the same. In Yvette’s obstetric work, measurements are probably more objective than in much of mine, and yet even so, she tells me that her department holds weekly audits where they all get together and take measurements, comparing with one another and making sure the entire department are following the guidelines and measuring in the same way. You wouldn’t think that there was any need for experienced sonographers to go through this process every week, and yet they do, such is the ease with which one can fall into new habits.

Mobile dog pregnancy scanners obviously don’t work in a department, and even many veterinarians are often the only vet in their practice specialising in that particular area of imaging. Without a community of people to share scans with, it can be easy to lose one’s way.

 

Recommended links

Animal Ultrasound Association Facebook page

Facebook group for small animal pregnancy scanning

Facebook group for large animal pregnancy scanning

Facebook page for veterinary echocardiography

Free monthly echocardiography newsletter for veterinarians

 

Tips for asking for help in Facebook groups

  • Always give the background and context of the scan (for example, how many weeks pregnant might the bitch be?), as well as yourself. For example, “I’ve recently done my level one training with VIS, but I only bought my scanner last week, and I need some reassurance” or “I’ve been scanning for six years and I’ve never seen anything like this!”
  • Always share real scan images, not photographs of the screen. Exported scan images are much higher quality, and include your machine settings on-screen.
  • If your machine is capable of storing cine loops, share these. They provide a lot more information than a single image.
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