FAMILY MEDICINE POCUS SPECIALIST CURRICULUM
1. BASIC THEORY
- Physics of ultrasound
- Different transducers and their application
- B mode, M mode, Doppler - application; BART mnemonic
- Interaction of US waves with tissue (reflexion, refraction, diffraction) - Artifacts (reverberation, ring-down, mirror image, enhancement, attenuation)
- Knobology of ultrasound machines, manipulative skills (sliding, rotating and tilting)
- Regional echo-anathomy
- Thyroid gland: size evaluation, echogenicity, vascular activity;
- Most common pathological findings of thyroid gland (changes in size and echogenicity, nodes, cysts, calcification)
- Neck lymph nodes - size, shape, hilus, echogenicity
- Salivary glands evaluation and common pathology (tumors, cysts, stones)
- Carotid arteries - CCA, ICA, ECA - size, position, recognizing ICA from ECA (position, resistance, waveform, branches) intima-media thickness, plaques (size, surface, fibrous vs. calcificated...), stenosis % measurement (area, flow speed - Vmax); RI measurement; kinking, coiling.
- Vertebral arteries - position, flow evaluation
- Scanning methods - Normal tissue, evaluation of glandular development, evaluation of lactiferous ducts diameter.
- Most common pathological findings (fibrosis, cysts, fibroadenoma, fluid collections, lipoma, lymph nodes, suspect malignant changes)
- Axillar lymph nodes evaluation
- BI RADS system
- Views and anatomical structures: Apical view, substernal view, PLAX, PSAX
- Apical four chamber and two chamber view: PW for diastolic LV function (E/A ratio); MAPSE, TAPSE; Doppler assessment of MV and TV; Doppler inspection for ASD and VSD. CW of AV.
- Substernal view: crux cordis, re-assessment of MV, TV; pericard
- PLAX: MSS, MV re-assessment, chamber sizes (RVOT, LA), aorta (diameter, separation, regurgitation?); walls measurement (IVS, PW), LVEDD, LVESD, EF.
- PSAX: Aorta, pulmonary valve assessment, LV eyeballing for wall kinetics.
5. ABDOMEN AND PELVIS
- Liver size, echogenicity, criteria for steatosis; Focal changes: haemangioma, cysts, deposits...
- CBD, hepatic artery and portal vein - "Mickey Mouse" sign.
- Hepatic veins and IVC - "Playboy bunny" sign
- Gall bladder size, shape, wall thickness, stones; pancreas - size, shape, echogenicity; spleen - size, focal changes
- Abdominal aorta - diameter, plaques or thrombus inside aneurysm...
- Paraaortic and parailial lymph nodes
- Kidneys. length, parenchim thickness and color, calculosis, hydronephrosis, cysts, angiomyolypoma, tumors;
- Urine bladder: volume, neurotic bladder assessment, walls - cancer, stones, diverticulum.
- Prostate: size/volume, shape, focal changes,
- Uterus: position, size, myometrium evaluation, endometrium thickness, ovarian size and cysts; Measuring accidental pregnancy (CRL. BPD, FL), spotting cardiac action.
- Douglas pouch, Morisson pouch
6. LEGS DOPPLER
- Anatomy of legs vascular system
- Waveform and Vmax inside AF, AP, ATA, ATP, ARM and ADP.
- VSM: compressibility, varicose changes, reverse blood flow during inspirium
- Deep femoral vein, polpiteal vein and deep crural veins - compressibillity, dilatation, stress test.
- Perforant veins of crurual and perimalleolar region - diameter, compressibility, stress test.
7. MUSCULOSKELETAL US AND SOFT TISSUES
- Principles of muscular and tendon scanning, signs of fresh and old lesions; Tendosinovitis
- Achilles tendon rupture
- Joint hydrops; Baker's cyst
- Ostephytosis in OA; Signs oh chondritis, entensitis, bursitis; fractures under US
- Soft tissues scanning: lipoma, atheroms, lymph nodes, vascularity of skin and subcutaneous changes, scanning collections of fluid (abscesses etc.).
8. LUNG ULTRASOUND
- Scanning positions
- Normal pleural sliding
- Normal A lines
- Pneumothorax, lung point
- B lines: interstitial syndrom
- Hepatisation of lungs
- C lines: infiltration
- Pleural effusion