Right, I think we can start with the intro. We've got quite a few people already here. The numbers are still slowly increasing, but, yeah, in the meantime, welcome everybody and thanks for joining us for this three part series on ultrasound webinars.
My name is Sylvia Anska. I'm a vet and I'll be chairing this webinar for you and one of the others as well. And this webinar is delivered by a good friend of mine and a colleague, Camilla Edwards.
Welcome and thank you very much for being here. Thank you. And it's a webinar sponsored by her company Fou.
And today's title is how to get the most out of your Ultrasound Machine. And I'll just tell you a little bit about Camilla first, and I'll pass it over to her and in the, throughout the webinar, if you guys have any questions, then, just pop them in the Q&A box and if we have time, then we'll answer them today. If not, we'll, we can always answer them in the next two sessions, the next following 2 Mondays as well.
So Kamilla graduated from vet school in Copenhagen in 2006. She then moved back to the UK and worked for a few years in mixed practise and a small animal first opinion practise before spending eight years in emergency work. There she then also gained her certificate in advanced veterinary practise.
In 2018, she went on to set up her own business for his opinion veterinary ultrasound or FOU. Camilla offers peripatetic. That's always a hard one tone peripatetic ultrasonography service, and teaches ultrasound online and in person through her for website and also for various ultrasound machine companies.
So, very, very glad to have you with us, Camilla, and I won't take any more of our precious time, so over to you. Great. Well, thanks for that introduction, Sylvia.
It's really nice to be introduced by you. So today we're gonna talk about how to get the most out of your ultrasound machine. I just wanted to add a little bit more background to, the introduction, just so you get a feeling for who I am and what I'm about.
So, I grew up on an ostrich farm in Essex. I have Danish parents, so I went to university in Copenhagen, Denmark, as Sylvia mentioned. I worked in, GP vet practises all over East Anglia since qualifying in 2006.
And worked in quite a few emergency and critical care hospitals as well, in East Anglia. So my background is very much GP practise. But I really wanted to, narrow what, what I was looking at and looking at peripatetic ultrasonography, which was a real passion of mine.
So, I started, locuming and offering a peripatetic ultrasonography service in 2018, which has taken off. I also started teaching, with some ultrasound companies, and that also grew, into starting my own online courses in 2020 when COVID hit. And we've had so far, over 200 students go through those courses.
And, also teach in practise as well. So, and there's lots of new stuff coming up with FOU in 2023. But We today, we're gonna talk about how to get the most out of your ultrasound machine.
So, the reason I chose this, title for, for the webinar is because a lot of the students I teach have come across lots of barriers when it comes to using their ultrasound machine. So these barriers, might consist of your not got enough time. You might not, believe that you are capable of learning ultrasound.
You might believe that your machine is not good enough. And you might find it difficult to access training either, financially or time wise, or your location. It's difficult.
So I want to break down a lot of these barriers to get you using your ultrasound machine. A lot of you have a machine in practise already, sitting there, gathering dust. And we really need to break down some of these barriers so that you can start using them.
So the first thing I want to talk about is the barrier of time. So what is the problem with time? Well, we don't have enough of it.
It's, not expandable. It's not flexible. We often feel pulled in multiple directions.
So we may have lots of responsibilities, for example, Childcare, or our hobbies, or, caring for an elderly relative, we, we feel pulled in lots of directions, and we feel like we don't have a lot of choice over how we spend, our time. So how can we fit in a new skill, a skill that takes time to develop, like ultrasonography? So the solution, we need to break it down, and, and, and really break it into little chunks so that we can, make it much easier on ourselves.
We can't expect to straight away be able to do full abdominal ultrasound scans, or echocardiography from day one. It really is a matter of learning a bit, getting good at it, adding on, adding on, adding on. And that is the way to learn ultrasonography.
So we start by making it easy to scan. So, do you have your ultrasound machine tucked away in a bag, in a cupboard, in the furthest room where it's, you can't even get into the room very often. That's probably an overexaggeration, but I have seen a lot of practises where it really is quite difficult to get the ultrasound machine out, and use it.
So, my top tip is to make it easy to scan, keep the ultrasound machine easily accessible. Usually, in most GP practises, that's in prep, because, yeah, that's where there is hustle and bustle. There's often animals getting, prepped for surgery, and you may be able to just pop the probe on for a minute and just practise.
The second thing is to create a habit of practising. So, this might, involve just a small step, like turning the machine on daily, for example, after consultations, before surgery. Turn the machine on, you're much more likely to use it if it is already warmed up and ready to rather than, perhaps, resorting to your usual switching the X-ray machine on, which you you're used to doing.
So if it's already on and ready to go, it may be much easier to just put that probe on just to try it. Tip number 3 for getting rid of the barrier of time is to find, find a friend, a reliable regular friend of the doggy kind. Cats will do as well, but I, it's pretty rare, you'll get a cat that is, a tolerant of a regular practise of ultrasonography.
But if you've got a dog or a member of staff has a dog that they can bring in on a regular day, that is really useful for practising your skills on. Also, if you can find a friend of the human kind, so either another vet or a nurse who will help hold a vet who wants to learn ultrasonography as well, and that you can learn together and hold the dog for each other, that's really useful. My 4th tip is actually scheduling time.
So, schedule, the dog, the machine, clear the diary. So, clearing the diary for performing an ultrasound scan is, is quite, key. I often see scans booked in for people to do, Between bitch phase or whatever.
And you wouldn't expect a surgery to, be magically squeezed into a particular time. We need to schedule the right amount of time to be able to perform, a, a good ultrasound scan. And make that commitment to yourself.
So, if you schedule some time to practise, whether that's in your own time or whether that's with a supportive team within the working day, make that commitment to yourself. I know, in general practise, you make that commitment, and the next week, there'll be an emergency. But if you've got that regular slot, sometimes you will get that practise in, and that is what will drive your skills forward.
OK. So, second, issue is your self-belief. That's, that's a real key thing I hear from a lot of my students.
I hear, I'll never be good at ultrasound. I can't tell normal from pathological. I'll miss something that another vet will see.
These are very, fixed mindset, statements. So we rather than thinking about, how We could grow and how we can learn, moving forward. We're really focused on comparing ourselves to other vets, and the imposter syndrome kicks in, and the perfectionist, attitude that we all suffer from sometimes, really kicks in.
So that can be a real problem with ultrasonography, especially when, it's seen as, an alternative to possibly X-ray. Although they do very different things, and we should be, they should be seen as complementary to each other. Often, if we're a bit nervous of doing ultrasonography, we can be guilty of just taking, taking another X-ray rather than sticking the probe on.
So, what can we do about self-belief issues? Well, keep it simple. Keep your goals really simple.
So, possibly your goal is to do an abdominal fast scan or practise an abdominal fast scan once a week, or just practise on one organ. You may still do more than that, but just focusing on one single area you want to improve on can really, help drive your skills forward. You want to absorb, observe when you're having these negative thoughts, when you catch yourself saying, so and so would do a better ultrasound than me.
I'll wait till they're available, or my scanning skills are not worth charging for. Or it's not fair on the patient to sedate for my scanning skills. Just observe yourself thinking that and think about how you could react differently, or how you could take a step towards doing, a scan, whether that's not necessarily a full scan.
And someone else does repeat it, still get yourself scanning so that you, you're trying it out and you're learning. So, yeah, my top tip number 3, really is just start scanning. Just know that the more times you do it, the more your confidence will grow, the more you learn, the more you see what normal is.
So the more times you can do it, the more cases you use it in, the better you will become. So this is a big one, your machine. So, the problem, you might not have the most up to-date machine in your practise.
Believe me, I've seen, I've seen them all. There are some, really difficult old machines out there. But, There's still ultrasound machines.
You can still get some information which might benefit your patients. And the thing to do is to work with what you've got, and then update when it becomes financially viable. So, don't wait until you've got a new machine to learn.
Start using that machine, which is an old machine, gathering dust in the corner. You're not sure what the buttons do and which ones are important. That is a really big one.
That it is, as I've written at the bottom as well, it looks so complicated. There are lots of buttons on an ultrasound machine, but we will talk about in a minute, some of the key buttons, that your ultrasound machine has. And another one is that you're worried that if you start playing with your ultrasound machine, you might break it for the next person.
And if you've got people who are more skilled, at ultrasonography and maybe are a bit protective of the machine, you're worried that, you might change a setting and it might not function in the same way for the next person. Really do not worry about that. Most things will reset themselves when you switch the machine off and switch it back on again.
It's very difficult to change things on most ultrasound machines permanently. So, really want to encourage, a sort of playfulness and an experimentation. So, with the buttons, push them to the extreme so that you see what changes it makes to the image, because that way you'll understand what, what nuances it's, it's doing when you're, when you're only changing it a little bit.
OK, so Even with your older machines, you can get useful information for your patients. And there are really only 5 key buttons, which you need to know about to start scanning that really influence how, your image is optimised. And they are on most machines.
If you can't find those buttons, I'll help you. Send me your make and model and a picture of, of the keyboard, the control panel, to Camilla at fou.co.uk.
I can help you get started if you can't find your buttons after this lecture. So the 5 key machine buttons are overall gain, time going compensation, also known as TGC. Frequency, depth, and focal zone.
So we'll go through how to find those buttons, and what they do. So our first button is the overall gain button. So this amplifies returning echoes.
So if we imagine on our screen here, we have the image, this, convex image from microconvex probe. If we imagine the probe is up here, it's producing the image down here. So everything closer to the probebe, and the surface of the animal is up the top here.
And everything deeper into the animal is down the bottom of the image. So, from the probe, sound waves are sent. They hit something and are reflected back to the probe.
And depending on how strongly they're reflected, how much energy they return with, determines how bright the pixel that is left on the screen. So determines how bright that dot is on the screen. So, what the overall gain does is it amplifies any of those returning echoes.
So if it was originally a weak returning echo, it will be slightly stronger. And if it was a strong returning echo, it would be even stronger. So it appears brighter and brighter on the screen.
So we can see here, I'm turning this knob and the image is getting brighter. I turn it the other way and the image gets darker. The button on most machines is either called B or game or auto.
We'll have a look at a few different machines, here. So, in this top left machine, we've got a Sonosy MTurbo, and we've got an auto gain button here. And that's, is a button which some machines have, and it sets a sort of average what most people would be comfortable with.
It is about Your own comfort. And it will depend on what room you're in. So if you're in a bright room, you'll want to increase your overall gain, to be able to see what's on the screen.
Whereas if you're in a dark, dark room, you'll want to decrease, the overall gain. The The machine down here, the mind ray, has an overall gain knob that you turn, clockwise to increase, the overall gain and anti-clockwise to decrease it. The Sonescape here in the bottom right has a button named Auto, which, again, you can, turn clockwise to increase the gain, anti-clockwise to decrease the gain.
But also, you can click it because it has an automatic gain button. So that will, again, reset things to sort of your average. On the Chisol machine here, we have a button labelled B, which again, you can rotate to increase or decrease the overall gain.
So moving on to the next button, which is a similar concept, the time gain compensation. So, again, it amplifies the returning echoes. But it does it at specific depths.
So you may have seen these, sliders on lots of machines. And they are, they represent each one represents a level on the screen. So here, I'm just playing with the sliders, and I've pushed, half of them over to the left.
Where, we're decreasing the gain on that level, and half of them over to the right, where we're increasing the gain on that level. And that's why we're getting an image which is, bright, and then dark and then bright and then dark. What we're aiming for is a uniform image.
And when we've got, sound waves coming from the probe, Into the animal, hitting, something and reflecting back, you can imagine that sound waves, which have only travelled a short distance, will return with a bit more energy and be quite bright from nearby. Whereas if they have travelled further, they have attenuated a bit. Lost some of that energy, and they'll appear darker.
So we often need to increase the time gain compensation deep in the image, slightly compared to the, top. So we have sort of a diagonal. Slightly towards the left at the top, slightly towards the right at the bottom.
We also might need to change if, for example, we are imaging something with a large body of fluid. So, for example, the bladder, because as the sound waves travel through the bladder, they don't attenuate so much. So we get it a little bit too bright beneath it.
So we might need to adjust, if we're looking at bladder or a large body of fluid. So here's a couple of different ways that machines have a time gain computation buttons. The most common, I would say, is the, the sliders here.
So we, we can see each individual slider. And that can also be represented on a On a touch screen, a lot of the new machines have got touchscreens as well, so that you can also see the sliders on, on a touchscreen. The other way is like this Sonosy, machine, it has a near field and a far field.
So rather than having lots of different levels, it just has two levels. One is the near field, one is the far field. And sometimes you might have 33 levels, each with their own knob that you turn to the left or the right, to make it darker or brighter.
So time gain compensation. If we have the sliders, alternating left and right, we get an image like this, a stripey image. And what we're aiming for is a uniform image where we have equal brightness over the image, but we really want to do this while we have the probe on an animal.
It's really good to do over the liver because it's a nice, deep organ, and we can check that the overall, Gain is, is is uniform throughout the image. Moving on to frequency. So frequency, we all, remember from, we might have, repressed it from, from, university days, but, it's measured in hertz, and 1 hertz equals 1 wave, sound wave per second.
And this gives us our pitch. And we get a, a better resolution with a higher frequency. The button is often, a, a knob we can turn again.
So, on this mind drain machine, it's a, it's a button that is shared with another function, so we need to press it first before turning it. And often we'll see that adjusting up in the top left hand corner of the screen. A little bit tricky to see on a, on a video like this, but you will be getting a value, usually in the top left, that will, be changing as you turn it.
Some machines, you can turn and it will reach the end. And some, it will just go in a loop. So, just watch out what you're doing, whether you're actually decreasing it or whether it's looped around to the highest frequency again.
So frequency, It's important to understand spatial resolution when it comes to frequency, and then understand axial resolution. So, axial resolution is the ability to distinguish two structures, a separate parallel along to the the sound beam, and this is totally dependent on frequency. So, at low frequency, you may have two dots or lesions, within the animal appearing as one on the image.
Whereas with a higher frequency, those two same lesions would appear as two. So, I'll just demonstrate that. So we have, a probe up here.
On the right-hand side. And we have the sound waves being emitted. We have these two blue dots represent 22 lesions or, two separate structures, within the animal.
Over here, the triangle represents the image and what we're seeing on the image. So, here, we've currently got quite a low frequency, sound wave being emitted from the probe. And therefore, these two dots here.
Are within one wavelength. Of the sound being emitted, and that means that they cannot be distinguished from each other, and therefore on our image we just get one dot showing. So how do we improve this, this image when we're not getting a very sharp, well defined image, and we, we may be even missing things with, with this lower frequency.
Well, if we increase the frequency, so now we have a much shorter wavelength, and therefore, these two dots are now, over a wavelength apart, then they will show up on the image as two separate lesions. And this means that the higher frequency, we're just getting much better resolution on, on our image. What we must, observe, though, is that with the higher frequency, we're not able to penetrate as far into the animal.
It's attenuating, it's losing energy, because it's travelling, so compactly over a, a short distance. So this is where frequency and depth really interact with each other. So a high frequency, as we can see, gives a great resolution, but we'll lose energy really quickly.
So it won't manage to penetrate deep into the tissue. And conversely, the a low frequency gives less good good resolution, but keeps more of the energy because it's effectively travelled less far and can penetrate deeper into the tissue. So the golden rule, when it comes to frequency and depth is you should adjust your depth first so that the organ of interest takes up 3/4 to 2/3 of the screen.
So, if that's, your liver, then you've got, got a really quite a large depth on. And if it's a really superficial organ like the spleen, then you've reduced your depth quite significantly. And then you set the frequency to as high as possible for the bottom of the image.
So, you will notice, as, when you've set your depth, when you adjust the frequency, it will, It will improve the quality of of the top of the image, the higher you go, but you want to be able to see the bottom of the image, the bottom of the organ that you're interested in as high quality as possible. So where do we find the frequency button? So on the top right machine, we've got an EDA machine, and we've got, a nicely labelled frequency button on the touch screen.
We can also see there the time gain compensation on the touch screen, those sliders there. On lots of machines, we will have a button near the screen. So like this Phillips machine down in the bottom right, we have the, the knob below the screen, and the information about what the knob does is just above it on the screen itself.
That's the same for the Sonescape up here on the top left. We have the button. And that corresponds to, what is written on the screen above it.
So, for these machines, this will say frequency, and you might need to, click the button. You might have a couple of choices, and you just need to click so that frequency is highlighted, and then you can turn the knob to adjust the frequency. Again here on the mind Ra machine down here on the bottom left, we have a button where we can switch between frequency or focal zone.
And that is a matter of just clicking the button until frequency lights up, and then we can increase the frequency by turning clockwise and decrease the frequency by turning anti-clockwise. So We now know that depth is really important, when it comes to, taking an image and getting the frequency right. So we always adjust the depth so that the organ of interest takes up 3/4 to 2/3 of the screen.
Here, I'm on the Mind drain machine again, and again, it's a button which has two functions, often shared with Zoom, but you want to choose depth, and then you can adjust the depth. I find all the machines do it slightly differently. Whether it's clockwise to increased depth or anti-clockwise, it varies from machine to machine.
So you need to learn what your specific machine does. But just, just experiment. And what you will find is there is a scale.
On the side, on, on the image that says usually counts the centimetres that you are penetrating into the, abdomen or, or whatever you're imaging. And so you can increase or decrease that depth. .
But do that rather than, rather than assuming that at 3 centimetres, I'd need a frequency of, of 10 MHz, rather than doing it that way, actually look at the animal, adjust the depth, and then adjust the frequency. So here we've got, again, a few different machines. Up here we've got the chisson, which has a little lever that you have to push forward or backward to change the depth.
On the sonar site down here in the bottom left, we've got two buttons. So one that increases and one that decreases depth, depending on, on which one you pressed. And then another Mind Ray machine down here, which shares, its function with Zoom.
So you just click between these two. And you want the, the depth to be highlighted, and then you can turn, turn the knob. And on this EA machine up here, we can see it's a, a knob that we can turn rather than on the touch screen.
It's on the control panel. So let's look at a few images and, and sort of critique them. I always think it's a bit like Goldilocks and the Three Bears.
So, we can have, this is a kidney. We've got the, the cortex of the kidney out here. We've got the medulla of the kidney in here.
But we can see we're, we're missing a bit of the cortex down here. So, potentially there could be some pathology. Just, just out here.
So this is far too shallow. These 3 kidneys are the same from the same animal. We can see that, in this image, even at the same frequency, there is, our eyes just can't see in as, as much detail when, when the kidney is compressed onto the screen.
We're wasting a lot of space here. The machine is spending time creating this image. So the quality is just not going to be as good up here.
So this image is too deep. And this is really what we're aiming for. So we, we want to get, the organ of interest, taking up 2/3, 3/4 of the, the image.
We want to see just beyond, to check that there is no masses or, changes just beyond the organ itself. And, and so this image is just right. So the 5th button that we're really interested in is the focal zone.
So it's important to understand that the the ultrasound beam, as it as it comes into the animal is. Is not 2 dimensional. Although we're getting this 2 dimensional image, the beam sent out is actually 3 dimensional, it has a thickness to it.
And it's not the same thickness all the way down. And the way that the ultrasound machine makes this two dimensional image is at each level, it takes an average of what's going on at that thickness. So if if we've got a much narrower beam, then we're getting a much more accurate impression of what's happening inside the animal.
And where the beam is narrowest is at the focal zone. So we'll have a, have a look at how that influences images, in a minute. But I just want to show on, on this machine, it is the, the mind ray again, where we are, we, we have a button that is shared between frequency and focal zone.
We need to click on it, so that it adjusts to the focal zone. And sometimes it's called focus as well. And then we can adjust it by rotating.
So that causes the this little arrow to go up, move up and down the screen, depending on which way you rotate. The knob. And Where that arrow is corresponds to where the focal zone, so where the narrowest beam, part of the beam is and where you're gonna get the most accurate image.
So focal zone has a big influence on lateral resolution. So this is the ability to distinguish distinguish two structures as separate perpendicular to the sound beam, and this is dependent on the sound beam diameter, as I was talking about. So where the beam is narrowest is the focal zone, and that's where we get the best resolution.
Below the focal zone, the beam widens quite a lot and we get much poorer resolution. We can put multiple focal zones on, on, on one image. So some machines will allow you to put 6 or 7, focal zones on.
So, why don't we just do that? Then we'll get a great image all the way through. The problem with this is that the computer needs much more thinking time to interpret all this information that's coming in.
And what happens is it slows the frame rate of the image. And so there'll be a slight delay compared to where your hand is and what your hand is doing, and what is coming up on the image on the screen. And, that can be extremely frustrating if, if things are not happening as you perceive, exactly at the same time, that can be very difficult to, to get good, good images then.
Right. So, understanding the lateral resolution and the focal zone. We, again, we've got the probe up here.
Here, we're just looking at the thickness of the beam, rather than the, the sound waves. And we can see at the focal zone, which is represented by this arrow on our image. We can see two lesions.
And because they're at the focal zone, and, and they're lateral, they're perpendicular to the, the, sound beam, they are showing up as two separate, lesions on the image as well. However, if we're looking at something which is, below the focal zone, where the, the beam really kicks, kicks out, we'll just get an average of what's going on there, and that will appear as one lesion. So you can see that it's, it's much more poorly defined in that area.
And you won't get as nice crisp image. So it's really important to, to move that focal zone to the bottom of the organ of interest, if it's a big organ like the liver. Because then it will all be contained with above the focal zone, where the, the, the thickness of the beam is narrower, before it, it kicks off and, and goes really wide.
Or if it's a small organ, so, for example, an adrenal gland, we really want the focal zone to be on the level of the adrenal gland. OK, so Oh. We've, mixed up a slide there, I think.
So we have, yes. So this, this is the focal zone. It just says, depth on the, on the slide.
So we are, on the EDA down here, we're looking at the focal position and, and the focal zone. It's two separate buttons here. So here we can see, we can move the focal position.
With this button, and we can move the focal number so we can put 3 focal zones on there. But really, it's more important to have an idea of where your focal focal zone is. And get it in the right spot.
Again, this machine in the bottom left, the Phillips, has a button which corresponds to, some information on the screen, so we can see that, we can click between how many focal zones there are and where the focal position is. And then rotate that knob to move that. On the chisel up here, it's a lever that we can move.
up or down to move that, that arrow on the screen up or down so we know where our focal zone is. I should just mention if you have an ECO tame machine, they, the focal zone is often moved by moving the track ball in the middle. And then finally over here we have the Sonosy MTurbo, so some machines have this button missing.
So where is it? Well, the computer is inside is, automatically adjusting it, depending on where you are assigning your depth and your frequency. So it's really important to get that image optimised for everything else in these machines that don't have a focal zone, because Otherwise you're not optimising for focal zone as well, and so you will get a poorer image overall.
So, the 5 key buttons on your ultrasound machine. The first one's overall gain, and that uniformly amplifies all the returning echoes, so it makes a whole image brighter or darker. The second one is the time gain compensation.
And this equalise equalises amplification from deeper structures. So you need to aim for a uniform image at all depths. And remember, we might need to tone it down slightly at the top, of the image, and then increase the amplification at the bottom of the image a bit.
Frequency, we improve our axial resolution. And we always have as high a frequency as possible as your depth will allow. So really key to have your depth in the right position before adjusting your frequency.
So the depth, you should have, You should aim for your, the organ of interest taking up 3/4 to 2/3 of your image, and it basically shows how shallow or deep into your animal your image is. And then finally, adjusting your focal zone. It's the button that's often forgotten about, but it really can make a difference to your image quality.
So apply the focal zone at the narrowest part at the organ of interest. This is the narrowest part of the beam, and it's got the best lateral resolution. So if we've got a large organ like the liver, we want it at the bottom of that organ, and if we've got a small organ, then we have it placed on that organ.
OK. So that was a big barrier, your machine. Moving on to the 4th barrier, we have training.
So, the problems that I encounter from my hearing my students talk, with training is often cost is an issue. You often go on a course and learn on a machine, which is different to your own machine, and then bringing it back and applying it can be quite tricky. And also, the image quality might not be quite as good on your own machine as in on the courses that you're going on.
And then a lack of ongoing support can be a real problem, because, although one day, ultrasound courses are great and you do learn a lot, you really need to maintain that learning, to get good at the skill of ultrasound. So the solutions. Obviously, courses are available.
There's online courses and in-person courses. Both have their place, absolutely. FOU offers both online and in-person courses.
We have a basics course and a, and a trickier bits course. Also teaching in person. Just think about what machine are you going to be, learning on, on that course, and is it gonna be easily, applied to your own machine when you get back to your practise?
My in-person teaching is, on your own machine, in your own practise for that reason. And then finding a mentor, so you can get that ongoing support moving forward. So, that's, if you've got someone in your practise who is, good at ultrasound, and does a lot of ultrasound, try and ask them if they'd be willing to mentor you, talk about a case, once a month, or, be someone that you can go to if you've got queries and questions, because getting that ongoing support is, is really key.
And that's one of the reasons I've set up, a fou Club, which is, membership, where we discuss cases and, have monthly content, also, to learn at a, at a pace over a prolonged period of time, ultrasonography. So, we've talked about a lot, in this webinar, from physics to, mindset. So there's been a lot, but I think it's really key, that we get past some of these barriers that we, put up to oxography, because it is such a great, Useful tool, in practise, in general practise as well.
And because ultrasound machines are getting so much better, we can get so much more information from them. And we'll be seeing that in, particularly in my third webinar of this series, 10 cases, where ultrasound made a difference. We'll be looking at lots of images in that, webinar.
But in this one, we looked at time and how we can, overcome that barrier, by making things easier. Have your ultrasound machine in an easily accessible place, scheduling time and trying to stick to it, trying to find, a, a, a dog to regularly practise on, and, finding someone to pair up with that, that will support you in this as well. Working on your self-belief.
So just observing when you really make those statements, I can't, or someone else should be able to, should do this and would do a better job than me. That, that sort of comparisonitis, and perfectionism. We need to get beyond that by just starting to scan, because that is gonna be the way that you really improve these skills.
Just start scanning. And then we talked about your machine. So, even if it isn't the greatest machine in the world, just get started.
Just start using it. Find those 5 buttons, so your overall gain, time gain compensation, your frequency, your depth, and your focal zone. And that will help you to optimise your image and get the best quality image you can.
And then get training, get support, with online courses, in person. And getting some ongoing support, mentoring moving forward. So where can you get more help, after this webinar?
You could go to www.OVu.co.uk.
I have a free ebook on my website there. That summarises a lot of what's gone on more of the practical side, of what you need to know and how to get started on your ultrasound machine. If you're struggling at all, you can email me, [email protected].
I just want to tell you about the webinar that's coming up next week, the Fou Guide to the Complete Abdominal ultrasound examination. So this is really focused on what a GP, vet needs to understand and what, what, what questions we need answered, in that. So I hope lots of you will, will join me in that.
But if you do have any questions, then, please do, do ask them now, and, I will be delighted to answer them for you. Hello, hello. Thank you so much for that.
That was amazing. So yeah, we have some questions coming through, but before we we do know, I totally understand what you were talking about with the with regards to like the mindset and your self belief, because I mean I absolutely love ultrasound, but there's always a bit of an imposter thought at the back of my head. So, thank you so much.
What I found really, really handy was the 5 key buttons. That was such an amazing sum up. And actually we have a question, linked to that.
So somebody was asking us, you know, those little handheld scanners that are. Out and I've seen sort of a few different ones about the, you know, the ones that you can link up to your phone, and they seem super, super good and I've seen them even I've seen them used, but are you able to change all of these settings you were talking about and produce as good an image? Yeah, so a lot of them work on, on AI.
So, make a lot of assumptions. So some of them are, are, some of them are good and some of them are not so good. I, I've reviewed quite a lot of different machines, including, the Butterfly and the Clarius, and you can find my reviews on my website, to read a little bit more in depth about them.
But absolutely, you, you can get a good image quality with them. And for cage side scanning, they're absolutely fantastic, some of them. Yes, you do adjust things on them.
So you can absolutely adjust depth, you can adjust gain, time gain compensation. The things that they have a little bit more, adapted to AI is the frequency and the focal zones. And for that reason, it's so important to get your depth right.
Otherwise, they will be, aiming at something different. They'll be optimising for something different. Then you are wanting to optimise for.
So it's really important to, yeah, make sure you've got that, that depth right and all the things that you can optimise for, that you do that. But yeah, a lot of them, you can, can do a few, a few of those, those buttons you will find on them. Yeah.
Perfect. Yeah, no, I, I've heard about some of them, and I've seen them sort of used at conferences to sort of showcase and They looked really, really good. Perhaps they were, they were the ones that you've reviewed as, the really good ones.
So, my actually follow-up question for you was, where, where can we find the, the reviews you've done? So, yeah, so if you go to www.OVu.co.uk, in the menu, there's, ultrasound machine reviews.
So. There, there's quite a lot of machine reviews on there. I'm, I'm working my way through them.
There's some that I would like to review that I haven't done yet, but, . Yeah, that, that's there. There's also a, a quiz on there, so a little, a little bit of fun, really, but, you can do a, do a quiz, answer some questions on your budget and what you want to use an ultrasound machine for, and it should match you up with your perfect ultrasound machine.
So, I had a bit of fun playing with making a quiz on there. Yeah, quizzes, quizzes are great fun. They're fun and also kind of self, checking, isn't it, really?
So I, I hope it's useful. I, you know, I, I spent a lot of time trying to make the algorithm, so it would spit out the right answers. So.
Well, everybody listening, you better go and do this quiz next Monday, let us know whether it was useful. And if not, then, let Camilla know so she can make another one for more work. Yeah.
And somebody's actually asking, how can I become a member of the Fou Club? OK. Yeah.
So, doors are closed at the moment, but will be open soon. So if you, do sign up, to the free ebook at fou.co.uk, you will hear about that as soon as, doors open again.
Perfect. And I believe you're on some social media as well. I think I think I'm following you on Instagram.
Where is the best place for us to sort of know all the updates? At Camilla Fou on all the social media. So.
And, and before we wrap up, I actually have one, maybe a bit of a fun question, but, what, what are some of the things that you find that when you tell a Betty, whether it's experienced or new. You can see that they just had this light bulb moment. What are some of the things that people oftentimes do wrong and maybe you've mentioned it throughout your talk, but maybe like the top two things that, kind of, you know, the listeners can take away with them, but it's those kind of light bulb moments because you, you said a few things where I was like.
Oh my goodness, I was doing that so wrong. You know, so what, what do you find that vets, seem to be worst at when it comes to? So, so there's, there's, yeah, a couple of things that when I'm teaching, whatever group I'm teaching, there'll always be one or two people who don't realise how much pressure they're putting on.
And that might be that they're putting on too little pressure or too much pressure, but they're just not aware of how much pressure they're applying. So that's some it's a really key thing, because if you apply too much pressure, you might move the organ you're looking for right out of the way, and then you can't find it. And equally, if you're not applying enough pressure, there are some organs you just won't get to.
So, pressure is one of those things that we're just not. We're not tuned in to what we're doing. And also, when we panic, so when we can't find the organ, we have a tendency to either apply more, more pressure or release the pressure too much.
So just when, if you're really struggling to find an organ, think about how much pressure you're applying. And also, That, that, that thing about, panic. So, we've all been there.
We're trying to scan, and we cannot find the right kidney. It's, it's not there. It's nowhere to be seen.
But just taking a step back and breathing and just thinking systematically, it's in this region. I'm going to switch the depth as As as deep as possible, and then I'm gonna fan in that area to look for that organ, so I can systematically look through where I know the right kidney will be, rather than Just waggling the programme, that's a really bad habit that lots of vets get into. Absolutely.
I totally, you know, that was, that was, that was great. Thank you. And I think the pressure, your first point is, yeah, it is key.
It's, it's one of those things we don't really realise. And so, thank you for your insight. And we have somebody else was actually asking about, so, we've been talking a lot about vets, but do you have any specific information or training for vet nurses or techs?
I, I do, so I have a a course for nurses and techs as well. And it's, it's actually race approved, because I have a lot of American vets, vet techs going through that. So, yeah, that is, on the website as well, under courses.
So, yeah, I haven't left you out because I think it's such an important area that's developing. And I think in America, it's, it's, further ahead than in the UK. I was going to ask, because it's starting in the UK and in Europe, but it's still mostly the vets doing it, and We're so time poor and we need help.
So if, if we can have nurses help us with things like scanning, I mean, that's triaging patients, you know, the, the opportunities within, particularly, you know, my background is in emergency and critical care. The, the opportunities for nursing and triaging and using ultrasound is, is huge, I think. Yeah.
No, absolutely. I think it's such a It's a really cool piece of equipment and I think we just get very stressed using it, but, but yeah, we have another question that just popped up, . Which, I'm not sure I understand your question, whoever posted this, which better for mineral.
Low or high gain. Yeah, that's . Yeah, I'm not sure I understand either.
I, I wonder if, you know, they're, they're thinking about what mineralization looks like on ultrasound. So, mineralization on ultrasound appears very bright. So, that, that, you don't usually have to turn it down.
It appears very bright, and then it has an acoustic shadow. So basically nothing. Passes through that, whether that's bone or a eurolith, no sound waves pass through.
So we just get a, a, an acoustic shadow beneath it. So we get just black blackness on the, on the screen. But we don't usually have to adjust the gain.
I usually adjust the gain at the beginning of my examination. So I usually start with the liver. It's a nice deep organ.
And, I can get all those settings set up, initially. And then I don't change the game very much, over the, over the course of an abdominal examination. Perfect, thank you.
And 11 other really really quick question before we wrap up so you obviously said that you do sort of help in person and and online. What if somebody needs some help with their own ultrasound machine, but they're far or not in, in, in your country? So can you help them with their own ultrasound machine remotely?
So I, I will always give it a go. There, there's been very few machines that have stumped me, in the long run, so. Yeah, if you are struggling to find those 5 buttons, if you send me the make and model and a picture of your control panel, I can often figure it out with you.
Whether that's experimenting, you know, I can narrow it down to a few buttons and then we figure out between us. Or, or I'll know already what button it is. Where were you when I was in full-time permanent clinical practise?
I would have had you on the phone every other day. And, somebody actually is asking, Laura is asking, did you say, you had a free online guide and where can she find it? Yeah.
So, if you go to the website www.OVu.co.uk, right there on the, on the front page, if you just scroll down a tiny bit, one of the top things on there is, the free ebook, and you just sign, sign up to get that.
Perfect, yeah, sign up and you get a free book. Oh, beautiful. All right, OK, so, a minute to spare, I should say my big thank yous to you and to Fou for sponsoring this, a 3 part webinars and for everybody else, if you have any more questions, obviously there's another 2, webinars the next following Monday, so.
Come and see us at those. I believe the, the second one is about abdominal ultrasound examination, and the third one will be about, small cases. Is that right?
Camilla? Yeah? That's right, yeah.
Just trying to fit 1010 cases into an hour. I'm challenging myself. Oh, wow.
OK. Well, good, good luck with that. And I, I might see you then.
Perfect. Well, thank you everybody for attending, for listening, and thank you, Camilla, for being here. Thank you.
