Cross-Training: A Sonographer's Overview

When I received an invitation to become a member of the ASE Vascular Council, I was delighted. As a member of the council my task was to support the vascular community of ASE members by communicating vascular areas of importance to the board, providing a forum for members with similar interests; and helping the scientific program committee develop educational offerings in the area of vascular ultrasound. I feel suited to guide the membership in these endeavors as I have faced the struggles of learning vascular ultrasound as a second specialty. Recently, the trend ofmany hospitals andmedical centers has been to combine the departments of cardiology and vascular medicine; my institution has followed suit and just opened a new Heart and Vascular Institute. This new idea makes perfect sense, as the majority of the patients with cardiac disease also have vascular disease. Those who do not may require vascular testing as part of their pre-surgical workups. These changes in reorganization are requiringmany sonographers to cross-train in multiple areas, and have further stimulated a need for the educational opportunities that this council has been developed to provide. In this article I will share the experiences in learning and developing my skills in vascular ultrasound that eventually led to my RVT credential. Working for an invasive cardiologist provided the perfect setting for me to learn about the arteries and veins outside the limitations of echocardiography. The experience that first stimulated my desire to learn more was a patient who came in post cath with a large pulsatile mass in his groin. It was late in the day and the hospital vascular lab could not accommodate him. Using a regular adult cardiac probe I was able to locate the aneurysm, view the neck of the aneurysm, and with color Doppler, demonstrate the to and fro flow. After what seemed like several hours of probe compression, my excitement slowly faded, but we did eventually seal the neck. Soon it became a habit, after imaging the subcostal views, to follow the aorta as far south as possible, viewing the renal andmesenteric veins and arteries.When the physicians announced they were going to upgrade my system to incorporate a vascular package, I was a pretty happy camper! With the purchase of the vascular package came an offering for training. I spent three full days in class, learning the anatomy and physiology of the carotid system, and was able to get hands-on experience by scanning each of 11 classmates. After returning from training, I realizedmore than ever the challenge ofworking independently as a sole sonographer. I really struggled through my first dozen or so cases until I became more familiar with the anatomy and the courses that it may follow. (This was with a visiting technical support at my side.) My saving grace was the vascular surgeon who interpreted my studies. He made a point of commenting on them from start to finish. He commented on my technique, givingme tips on scanning, Doppler collection and plaque recognition. As in echocardiography, the physician-sonographer relationship is very important in producing a favorable outcome for the lab.