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How Do We Describe What We Do?
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Hello all,

We have been using the term "Emergency Ultrasound" or some slight variation of it to define what we do since 2001.  

In the last several years we have undergone significant growth and are looked upon by other specialties as leaders in this area

As we now strive to make what we do generalizable to multiple specialities and obtain approval of our subspecialty via ABEM / ABMS we have to come up with an acronym / term that accurately matches the field

Please keep in mind that the term we choose will reach far beyond the pure educational aspects of our specialty but have significant legal, governmental and financial implications

The acronym / term we choose will live with us for a very long time so it must be well thought out

I am sending this email to the section to solicit feedback / input

Below is a list that some have come up with each with pros / cons.  Feel free to choose from this list or suggest additional names



Bedside US BUS
Clinical US CUS CuS
Clinical Sonology CSono
Focused US FOCUS
Point of care US POCUS
Sonology Sono
Specialty –specific US =  SUS
Ultrasonography
Clinical Ultrasonography
Acute Care Ultrasound (ACUS)
Acute Care Clinical Ultrasound (ACCUS)



Any additional commentary as to why you feel a particular acronym / term is or is not suitable is welcome


I am confident there will be no shortage of replies here as we are a section loaded with members who are truly passionate about what they do.


Thank you


Rajesh Geria MD, RDMS, FACEP
Chief, Division of Emergency & Critical Care Ultrasound
Assistant Professor, Staff Attending Physician
Chair, ACEP Section of Emergency Ultrasound
Director, Emergency Ultrasound Fellowship
Department of Emergency Medicine
Robert Wood Johnson Medical School
New Brunswick, NJ
Twitter: @geriasonoMD
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Speaking from an international perspective, The term "Clinician Performed Ultrasound" is widely accepted in Australia and New Zealand.
In fact, the Australasian Society for Ultrasound in Medicine (ASUM) offers a Certificate in Clinician Performed Ultrasound (CCPU) and the University of Otago (NZ) offers an advanced degree using this term.
It neatly summarizes what we do.
Echocardiographers and ultrasonographers can wheel a machine next to a bed and perform POCUS.

Just some thoughts.

Scott

Scott Bomann, DO, RDMS, RDCS, FACEP, FACEM
Director of Emergency Ultrasound
Wellington Regional Hospital
Wellington, New Zealan
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I agree with Scott.  Clinician Performed Ultrasound entails obtaining images and then appropriately interpreting them for patient care by the clinician/provider.
 
Michael Osborne, MD, FACEP, RDMS, RDCS
Lexington, Ky


pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


"Clinician performed ultrasound evaluation" is long tho it encompasses both performance and interpretation.

Alex Rosenau, DO, CPE, FACEP
Senior Vice Chair, Dept. of E.M.
Lehigh Valley Health Network
President-Elect, ACEP
Associate Professor, USF
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


In a word: indispensable

Costas Kaiafas MD RDMS
Director of Emergency Ultrasound
Morristown Medical Center
Morristown NJ
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Colleagues,

While I agree that "Clinician-Performed Ultrasound" probably best encompasses and defines what we do, my personal opinion is that it's an awkward and cumbersome mouthful that ages me unnaturally as I arduously sound out this death march of syllables.  

I suggest that we do not necessarily need to define and encompass so perfectly with the term we choose.  

I suggest the term "Clinical Ultrasound,"  or alternatively "Clinical Sonography," or "Clinical Sonology."  Clinical US is both accurate and efficient, as well as being open to the future broadening of usage.

Personally, I have been using the term Clinical Ultrasound around my medical center where I am working to spread and formalize its usage to other specialties (led by EM of course) and it seems to go over nicely.

This probably only makes sense to me, but my impression is that it somehow communicates more confidence in what we do without having to spell it out so entirely and explicitly.



Thanks for listening.

Eytmology (and electronic music) nerds continue reading below regarding the suffixes -ograghy and -ology for your consideration.  Carry on.

John Gullett, MD
Assistant Professor
Co-Director of Emergency Ultrasound
Department of Emergency Medicine
University of Alabama at Birmingham


-ograpghy refers to a method of recording (primarily), also more specifically a method of writing, but also a field of study

-ology is a field of study

Wikipedia on Sonology:
Sonology is a neologism used to describe the study of sound in a variety of disciplines.
In medicine, the term is used in the field of radiology to describe the practice of medical ultrasonography.[1]
The term is also used to describe interdisciplinary research in the field of electronic music and computer music, drawing upon disciplines such as acoustics, electronics, informatics, composition and psychoacoustics. This sense of the term is widely associated with the Institute of Sonology, which was established by composer Gottfried Michael Koenig at the University of Utrecht in 1967 and later moved to the Royal Conservatory of The Hague in 1986.[2] The term has also been adopted to describe the study of electronic music at other institutions, including the Center for Computational Sonology (now "Sound and Music Computing")[3] at the University of Padua, Kunitachi College of Music in Tokyo, and Catalonia College of Music in Barcelona.
The term has been less commonly used to describe the use of sound for therapeutic and religious purposes.[4]



pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Hello World,

personally, I think of clinical ultrasound as any US exam that is directly connected to patient care (including studies done through radiology/cardiology etc) vs. non-clinical applications of US.
 
I am still in favor of the good ol' point-of-care ultrasound/sonography (POCUS > not to be mistaken with point-of-care cardiac ultrasound).
While Clinician-perfomed ultrasound describes best what we do, I agree that it's not a hot sell.
I would avoid terms like Bedside US, Focused US or Limited US because they are either too sloppy or restricting.

These are just my 2 €-cents.

Tobias

_____________________________________________________________
Tobias Kummer, MD, RDMS
Division of Emergency Ultrasound
Dept. of Emergency Medicine | The Warren Alpert Medical School of Brown University
tobias_kummer@brown.edu | 401.444.6480
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I think there's unlikely to be a perfect term that will satisfy everyone (hence the proliferation of POCUS, FOCUS, EUS, BUS, CPU, EPPU, SUS, etc, etc). That said, I'd be in favor of going with Clinician-Performed Ultrasound (CPU) as it's already gained traction internationally (see Scott's email discussing Australia/NZ) and isn't any worse than the alternatives (and is better than many in my opinion).

Makes sense to me to choose something that's already widely accepted elsewhere if the goal is to promote standardization.

Mike


Mike Stone, MD
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I agree with Dr. Stone, and I think there is value in coming up with a term and having us all use it as our field continues to gain traction. Clinician-performed ultrasound can be nicely shortened to CPU and is the best descriptor.  It would also encompass ICU based bedside ultrasound, EMT/field use of ultrasound, etc, which I think it should.

How are we going to come to consensus and then get everyone to use the term we decide upon?

Elizabeth

Elizabeth Schoenfeld, MD, RDMS
Division of Ultrasound
Department of Emergency Medicine
Baystate Medical Center
Tufts University School of Medicine
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I also agree with Dr Stone and Dr Schoenfeld that we could reach consensus in the terminology utilized. I am translating an important iBook into Spanish and had a very hard time translating the term "bedside ultrasound". In Spanish it literally would mean "ultrasound in the bed" so I changed it to "Ecografía Clínica Dirigida" or "Clinically Directed Ultrasound" which describes our targeted approach.

thanks,

Jorge
Jorge Otero  MD, MSc., RDMS
Associate Director Department of Emergency Medicine
Emergency Ultrasound Director
Waterbury Hospital
President Elect Connecticut Chapter of ACEP
Lecturer Health Policy and Management
Yale School of Public Health
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I agree with the consensus thus far.  My hospital refers to it at POCUS which is fine when you know about point of care ultrasonography. However, I've had patients as me magic related questions after hearing the term POCUS.  Our description should be encompassing of what we do and easily understood by patients and nonclinicians.  Since Clinician Performed Ultrasound describes what we do, already has international momentum, incorporates ICU & EMS and will be easily understood by patients, it gets my vote. 

ak    


Annahieta Kalantari, DO
Director of Emergency Ultrasonography
Aria Health
Philadelphia, PA
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


While "Clinician-Performed Ultrasound" is certainly accurate and better than many alternatives, I agree with Dr. Gullett that it is a little clunky. Specifically, the term "Performed" adds nothing to the description--all ultrasounds are 'performed'. It is only used to turn the noun "Clinician" into an adjective and so why not just use "Clinical"?

I really like his suggestion of "Clinical Sonology"--it is accurate and eloquent and nicely summarizes that this is a field of study, research and expertise, not just a diagnostic test. "Clinical Ultrasound" is also very good, maybe even a little more intuitive to the non-sonologist. But both I think are superior to Clinician-Performed Ultrasound.


Andrew Liteplo, MD, FACEP, RDMS
Director, Emergency Ultrasound Fellowship
Massachusetts General Hospital
Assistent Professor, Harvard Medical School
____________________________________
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I’m with Dr. Liteplo and Gullett on this one.  Clinical Sonology is short and descriptive of what we do.
 
Best,
Nova
 
Nova Panebianco M.D., M.P.H.
SAEM President Academy of Emergency Ultrasound
Associate Director of Emergency Ultrasound
Assistant Professor
University of Pennsylvania
Department of Emergency Medicine
3400 Spruce Street
Philadelphia, PA, 19104
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


As a brief comment about preferred terms I also support use of the term "Clinician Performed Ultrasound", or just "CPU" for short.
It is applicable to a range of clinical specialities and distinguishes itself from traditional purely diagnostic/formal radiological studies.
Point of Care Ultrasound also asserts the idea of clinician performed ultrasound but in my mind the term "POCUS" is too easy a target for mischievious comments and discredit for this important work.
Dr Mark Rewi   
Emergency Physician (FACEM, PG cert CPU US/ Echo Otago)
Middlemore Hospital
Auckland
New Zealand
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231



By that line of reasoning, isn't all of our ultrasound 'clinical'? Perhaps just 'ultrasound'

I would maintain that the 'performed' , specifically 'clinician performed' is what separates what we do from the sonographer/radiologist model.

Particularly if this is in use internationally I think this makes more sense (despite not rolling off the tongue...)

Chris Moore


pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Acute Clinical Ultrasound (ACU)
 
Acute: used for urgent/emergent patient assessment and management
Clinical : performed by clinicians actively managing the patient at the bedside
Ultrasound: 'cause an acronym using sonogram or sonography, "ACS,” is already commonly used, as is "CPU."
 
Peter
 
Peter Weimershiemer, MD FACEP
Associate Professor Surgery
ED Ultrasound Director
Division of Emergency Medicine
University of Vermont/FAHC
111 Colchester Ave
Burlington, VT 05461
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Should we take a cue from our marketing colleagues?

We could chose an acronym that less describes what we do, but rather provides a catchy phrase that is memorable and denotes confidence.

PLUS
Physician Limited Ultrasound

A-PLUS
Acute Physician Limited Ultrasound

AC-PLUS
Acute Clinician-Performed Limited Ultrasound


and to capture the youth in our field

EX-PLUS
Expertly Performed Leading-edge Ultrasound



Bob


Robert E. Kuhn, MD
Emergency Ultrasound Director
TEAMHealth Midsouth
Sts. Mary & Elizabeth Hospital
Louisville, KY 

pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Ultrasound is done by virtually all specialties - 19 departments in my hospital use ultrasound at the "bedside".
How do the following specialties describe their use of ultrasound? Do they use descriptors?

Optho
Ortho
Vascular surgeon
ENT
GI
Trauma surgeon
Hospitalist
Family medicine
Pediatrician
Intensivist
Anesthesiologist
Pathologist
Neurologist
PM&R
Sports medicine

Isn't the term "ultrasound" enough?  If our goal is to distinguish what we do from radiology, or perhaps even cardiology, why not assign THEM the descriptors like "Radiology Ultrasound" or "Echocardiography"? I actually think the term ultrasound has already evolved into meaning "a scan done at the point of care by a clinician taking care of a patient".  

PS: I also like the term "Piezoelectric Puzzle Unraveler" but thats unlikely to gain traction due to the fact that unraveler is not actually a word.
PPS: what if we just spelled it using alternating capitals like: uLtRaSoUnD.  This would represent folks from different specialities and folks at different levels of training (med students on up to attendings).

John Christian Fox, MD
Professor of Clinical Emergency Medicine
Assistant Dean, Student Affairs
Director of Ultrasound in Medical Education
UC Irvine School of Medicine
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


John has, once again, beat me to the punch.  As I have been reading the last few days of catchy acronyms I have been asking myself what is the advantage of giving a new name to an already known medical entity?  I cannot speak for your patient population, but mine cannot even remember the name of the blood pressure medication they take.  I assure you the pharmaceutical industry spent much more time, energy, effort, and $ on that drug name the patient cannot recall then we will be able to expend on coming up for a new and creative name for how we use ultrasound.  Do not get me wrong, I know we have spent a tremendous amount of time and energy educating our colleagues in medicine about how our specialty uses this technology in our unique environment.  However, I do not feel by coming up with a new name to describe our use of ultrasound we will move our use of ultrasound any further forward.  In fact I think the opposite is true.  Recall my patient who has no clue what medications they are on... 

Doctor...what are you doing? 

I am using ultrasound to see if you have condition X. 

Why are you using ultrasound?

It is fast, cheaper than CT, safer, and it helps me to save your life

Call me crazy, but in the world of patient marketing...sometimes the most simple messages are the ones that matter to our patients and help move the ball of understanding forward.

Respectfully,

Rob

Robert Blankenship, MD, FACEP
Chairman, Department of Medicine
Director of Emergency Medicine
St Vincent Fishers

Ultrasound Director
St Vincent Emergency Physicians


pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I concur with the good doctor Fox.
 
I understand the rationale for trying to differentiate what we (or any clinician performing point-of-care limited ultrasound) are doing from the comprehensive studies done by others.  I think the point is lost though when you have to repeatedly define the acronym because it is already in widespread use in other fields (i.e. CPU), sounds like another word (i.e. PLUS) or just sounds silly (i.e. POCUS--admit it, everytime you read that you think "hocus pocus").  I may be wrong but I think we are trying to convey that we (the clinician) performed a limited ultrasound at the bedside, a fact that I communicate by saying "I performed a limited ultrasound...".  When I don't have to write it out (on pre-printed or electronic forms) I prefer to note it as a limited emergency ultrasound study.  And if I'm forced to write it down, I'll go with EUS.
 
It's super-cool to have our own acronym, and someday (perhaps with an extensive Facebook campaign or celebrity endorsement) perhaps we'll have something immediately recognizable.  Until then we are still going to have to explain the concept to most non-emergency physicians (there is much greater awareness in academia but there are far more community doctors that have no idea), acronym or not.  But you have to start somewhere...
 
I'll vote for point-of-care limited ultrasound (PLUS) if I have to choose...but I'd prefer just to use emoticons. -----{]))))))))

Jason Gukhool MD RDMS FACEP FAAEM
Emergency Ultrasound Director
Greater Houston Emergency Physicians
Medical Director
Elite Care Emergency Center--League City
281-881-4872


pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


The terminology we use at our facility is similar
 
Focused- i do it and give you and immediate answer but may not interrogate every inch of the surrounding anatomy
 
Comprehensive- a tech does it and someone else interprets it (radiology)
 
I use this to discuss with my patients why we made need a follow up test or another ultrasound.
 
This also seems to work well for our billing department
 
I know it is simple but there is some beauty in simplicity
 
Then each specialty can practice within their scope of focused practice once they define such as EM as done
 
 
 
Creagh Boulger MD
Assistant Professor
Department of Emergency Medicine
The Ohio State University Medical Center

pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


To all
 
The Subspecialty subcommittee of the section, which has been leading the efforts towards subspecialty creation under Dr. Resa Lewiss”s direction, asked that Dr. Geria query the Emergency US community regarding the term and acronym.
 
Speaking for myself and others, we have very pleased with creativity and insightfulness of all the responses to date, and we want to encourage anyone else to respond.
 
I felt that you should know why we look for other terms than Emergency Ultrasound, which is the term we used in the ACEP Guidelines during the last decade, and is still is valid..
 
Subspecialty politics are interdisciplinary – broader terms may be more inclusive and bring along other specialties when we hit the rough and tumble politics of ABMS and ACGME to get approval..
Typically, we were informed, a new academic discipline is not named after a technology.  Our field may be the exception, but frankly we would have used the world “ Ultrasound”  initially if we thought it would fly.  Maybe it will, but other options should be available .
We are describing the academic field not just the application – the public, other physicians, and our peers in our field expect us to educate, research, and improve knowledge as we move forward.  The name should reasonably reflect that.
This field is for US experts, like fellowship graduates or practicing physicians which interest or expertise in this use of US.  We are not expecting the average practicing emergency physician to apply to this future subBoard.
The core knowledge basis is broad but is made of many applications that some specialties will never use. That creates a tough balancing act in regards to who this field will appeal to outside of EM and Critical Care.
Names and acronyms have implications, as Raj points out in his email, so that is why we want to carefully consider how we frame this field to the outside world.  We will be living with the term for a long time.
The purpose of the email was to elucidate creative ideas and topics regarding the name of the field and acronym, not to vote. 
Realize that even as we propose something that is appealing to our field and others, we may have to adjust as we get to the ACGME and ABMS world.
 
Keep the ideas coming, and hope this helps with the background.
 
Vivek
 
Vivek S. Tayal, MD, FACEP
Director, Division of Emergency Ultrasound
Professor of Emergency Medicine
Department of Emergency Medicine
Carolinas Medical Center - Main
704-355-3181
vtayal@carolinas.org
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


Although I often use EUS and POCUS in conversation I agree with others that an acronym isn't necessary. Along with all the fields listed, radiologists and cardiologists do point of care ultrasound too (TEE,MSK, developing countries, etc).

But if I'm forced to choose id go with:

Clinician Actuated Non-Invasive Bedside UltraSound (CANIBUS) - at least it would be popular in Detroit...

Leonard Bunting, MD FACEP RDMS
pererap
Posted: Tuesday, June 11, 2013
Joined: 8/31/2011
Posts: 231


I just hope there is consensus soon.  I just used "find and replace" to switch every instance of "ultrasound" on our blog to "Piezoelectric Puzzle Unraveler."

---------------------------------------------------------------
Phil Andrus, MD, FACEP
Assistant Professor of Emergency Medicine
The Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai
 
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