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11 Simulation Medicine
Fig. 11.12 The SonoSim
Ultrasound Training
®
Solution
anatomic
simulator uses simulated
ultrasound equipment, real
and simulated patient
anatomy, and real-time
dynamic scanning through
the imaging data set
141
Fig. 11.13 The Schallware (Berlin, Germany) anatomic simulator uses simulated ultrasound
equipment, real patient anatomy, and real-time dynamic scanning through the imaging data set
142
B.P. Nelson and D. Katz
Discussion
Pressure for efcient and effective training comes from all sides—learners, educators, patients, hospital administrators, regulatory groups, and others. There is growing evidence that simulation enhances ultrasound education, but incorporating this
technology remains a challenge at many levels. Funding for resources can be found
through educational grants, from administrators or malpractice insurers interested
in risk management solutions, or offset from revenue generated through billing for
clinical ultrasound studies performed in the department. In some institutions simulation equipment is a shared interdepartmental resource, so costs are spread through
multiple departments or built into institutional overhead.
Simulation is scalable in ways traditional hands-on training is not. Simulators
can recreate the same clinical scenario for every learner indenitely, allowing for
large-scale consistent training. It can demonstrate a high volume of pathology in a
short time compared to the unreliable ow of pathology in the clinical environment.
Over time, the upfront cost of a high-delity simulator purchase is often less expensive than the repeated use of faculty time and hiring models, and either purchasing
educational ultrasound machines or taking clinical machines out of service for
education.
Thus, simulation can augment ultrasound education for every level of learner,
including students, trainees, and faculty. It can provide an ongoing platform for
deliberate practice, competency assessment, and remediation. And simulation can
play a large role in standardizing assessment metrics which can be validated across
specialties or institutions.
Pitfalls
1. Failure to connect micro-tasks back to overall skill
2. Use cases to highlight how to incorporate ultrasound into overall care plan
3. Use each simulator appropriately—some teach proprioception, some image rec-
ognition, etc.
Key Recommendations
1. Use simulation to augment cognitive and skills-based learning, creating a safe
environment for deliberate practice
2. Incorporate task simulators, case-based learning, and self-direction in a multi-
modal educational approach
3. Collaborate with other departments for funding, expert faculty, and administra-
tive support.
11 Simulation Medicine
143
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B.P. Nelson and D. Katz
Chapter 12
Ultrasound Equipment andPurchase
Rachel Liu, Christopher L. Moore, and Vivek S. Tayal
Objectives
1. Review machine types in the point-of-care community
2. Review most common probe types in the point-of-care community
3. Discuss advantages and disadvantages of different equipment choices
4. Review currently available features that inuence machine selection
5. Outline costs
In many ways, the development of ultrasound equipment has facilitated the
expansion of point-of-care ultrasound (POC US). As machines have become more
compact, durable, and less expensive while maintaining high image quality, they
have spread to diverse practice environments. In the last decade, POC US has been
recognized as the fastest growing sector of the ultrasonography market, and now
nearly all major manufacturers have equipment that is targeted to this market [1].
Machines that “handle the rigors of the multi-user, multi-location practice environment” [2] have been driven by user needs with each year bringing new models for
consideration.
Purchase of a machine requires thoughtful deliberation, aided by knowledge of
machine hardware, intended operator skill set, site infrastructure, IT capabilities,
and workow logistics of the clinical practice environment. In emergency care
settings where a diverse range of applications are required, considerations related to
machine portability, transducers, image quality, adaptability, ease of use, durability,
R. Liu, MD, FACEP • C.L. Moore, MD, FACEP (*)
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
e-mail: chris.moore@yale.edu
V.S. Tayal, MD, FACEP
Department of Emergency Medicine, Carolinas Medical Center,
Charlotte, NC, USA
V. S. Tayal et al. (eds.), Ultrasound Program Management,
https://doi.org/10.1007/978-3-319-63143-1_12
145© Springer International Publishing AG 2018
146
R. Liu et al.
image archival, interface with quality assurance systems, workow, and connectivity are continuously being addressed with industry [3]. The purpose of this chapter
is to review basic considerations regarding machine form factors, probes, and other
features that are important for use in the point-of-care setting, as well as provide
guidance on the process of selecting, purchasing, and maintaining equipment.
Machine Selection
Point-of-care ultrasound machines are by denition more compact than standard
cart-based machines, as they are intended to move (Fig.12.1) to the patient as
opposed to remaining in a xed location. Within the eld of point- of- care ultrasound, machines are manufactured using different form factors. These are typically
classied as: “compact cart-based” (Fig. 12.2), “hand-carried” (laptop size)
(Fig.12.3), and “pocket-carried” (Fig.12.4); some interchangeability between different classications are made possible by accessories or machine modications.
For example, several companies offer setups where laptop-sized machines may
function as compact cart-based systems by mounting them on attached wheeled
carts (Fig.12.5). This gives the option to remove the laptop portion for independent
use, transport, and service. In addition, companies are now adding monitor-size
machines that can be set on a moveable pole or on a monitor arm (Fig.12.6 Monitor/
arm mounted—S series and TE7).
Fig. 12.1 Mobile Ultrasound
12 Ultrasound Equipment andPurchase
Fig. 12.2 Cart-based systems
147
Fig. 12.3 Hand-carried machines on cart
148
Fig. 12.4 Pocket-size ultrasound machines
R. Liu et al.
Fig. 12.5 Laptop machine
offcart
12 Ultrasound Equipment andPurchase
Fig. 12.6 Pole and arm mounted machine
149
The type of machine chosen for purchase depends mainly upon the practice environment of machine use. Wheeled cart-based machines are often the best form factor for emergency department or ICU settings, but would not be suitable for
nonhospital eld work. Likewise, smaller tablet and phone-sized machines may not
provide features robust enough for certain in-hospital scenarios. Different classications of machines have variations in mobility, durability, ease of use, image quality, access to advanced features, and adaptability to IT infrastructure. Most
companies offer a trade-in price for older machines, and recycling machines may
offset purchase costs.
Compact Cart-Based Ultrasound Machines
Compact cart-based machines are designed to be wheeled to the patient bedside
(Fig.12.2). They are termed “compact” as they are smaller than the nonmobile
systems that reside in radiology or cardiology suites. Ideally their widths and
depths are minimized, but they often have a large screen (Fig.12.7), space for
storage of equipment (Fig.12.8), and more functionality than ultrasound equipment with smaller form factors. Based on the additional features and parts
required, they are typically more expensive than other point-of-care machines
(2017 price range approximately $30,000–$80,000). They consist of central processing units housed in casing that accommodate multiple transducers (Fig.12.9),
internet connectivity transmitter (“wireless dongle” (Fig.12.10)), video output
ports (Fig. 12.11), a keyboard (Fig. 12.12), and storage bins. They are often
150
Fig. 12.7 Large screen
R. Liu et al.
Fig. 12.8 Storage towels