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)

2. NECK

  • 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

3. BREAST

  • 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

4. HEART

  • 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