Certificate in Clinician Performed Ultrasound (CCPU)

Transcription

1 Certificate in Clinician Perfrmed Ultrasund (CCPU) Syllabus Biliary

2 Syllabus Biliary Purpse: This unit is designed t cver the theretical and practical curriculum fr ultrasund f the Right Upper Quadrant Prerequisites: Learners shuld have cmpleted the ASUM Physics Image Optimisatin unit r accredited equivalent curse. Training: Recgnised either thrugh attendance at an ASUM accredited Right Upper Quadrant curse r equivalent. Assessments: Learners are required t prvide evidence f satisfactry cmpletin f training sessins, supervised ultrasund scans and dcumentatin in a lgbk. Curse Objectives On cmpleting this unit, learners shuld be able t: Demnstrate a detailed understanding f the grss anatmical structure and surface anatmy f the relevant rgan systems and the anatmical relatinship t surrunding rgans and structures. Attain prficiency in image ptimisatin in rder t enable apprpriate diagnsis. Optimisatin f clur flw and pwer Dppler Limitatins f clur Dppler Identify abnrmal gallbladder wall Identify gallstnes Identify bstructed biliary tree

3 Curse Cntent Anatmy Gallbladder Phrygian cap junctinal fld Lcatin beneath the interlbular fissure Rare intrahepatic gallbladders Cmmn bile duct Pathlgy Gallstnes Sludge Calcium bilirubinate granules and chlesterl crystals in thick, viscus bile Plyps Small, sft structures adherent t the gallbladder wall Imaging Prtcls Gallbladder Multiple views shwing maximum dimensins in 2 planes Demnstratin f measurement f gallbladder wall diameter Cmmn bile duct Tw r mre images with measurements f cbd diameter. One with clur r pulse wave Dppler demnstrating n flw in cbd Skills Gallbladder and cmmn bile duct imaging Identify ptimal transducer fr gallbladder: 3 t 5 MHz Identify multiple transducer lcatins t view gallbladder: subcstal, intercstal, lateral and superir appraches, Identify multiple patient psitins t view gallbladder: left psterir blique, left lateral decubitus, prne, upright Cmmn bile d uct Distal cmmn duct best seen by visualising head f pancreas Measurements Dimensins f nrmal gallbladder: Transverse < 4 cms

4 Length < 10 cm Wall thickness < 3mm Diagnstic criteria Nrmal Anatmy Characteristics f Stnes, Sludge and Plyps Acute chlecystitis diagnstic criteria: Gallstnes Gallbladder wall thickening Gallbladder enlargement Perichlecystic fluid Fcal tenderness ver gallbladder Intrahepatic ductal dilatatin Diameter f nrmal ducts nt greater than 40% f diameter f adjacent prtal vein Dilated intrahepatic ducts distinguished frm prtal veins by trtusity anr wall irregularity Cmmn bile duct dilatatin >7mm (May be abnrmal in yunger patients) Limitatins and Pitfalls Acalculus chlecystitis Multifactrial aetilgy ie ischaemia, gallbladder wall infectin, chemical txicity t gallbladder wall, cystic duct bstructin Emphysematus chlecystitis Mre ften in elderly and diabetics, nt ften assciated with gallstnes Gas develps in gallbladder lumen r wall Manifests as bright reflectins frm a nndependent prtin f the gallbladder wall Other causes f gallbladder masses Prcelain Gallbladder Echgenic arc with dense psterir shadwing Causes f Gallbladder Masses Other Causes f Gallbladder Wall thickening CBD dimensins

5 Larger in patients with chlecystectmy Intermittent r partial bstructin may be present in the absence f ductal dilatatin Causes f Bile Duct Wall Thickening all Thickening (Kurtz, 1996) Teaching Methdlgies fr the Right Upper Quadrant curses All curses accredited tward the CCPU will be cnducted in the fllwing manner: A pre-test shall be cnducted at the cmmencement f the curse which fcuses learners n the main learning pints Each curse shall cmprise at least 4 hurs f teaching time f which at least 2 hurs shall be practical teaching. Stated times d nt include the physics, artifacts and basic image ptimizatin which shuld be prvided if delegates are new t ultrasund Learners will receive reference material cvering the curse curriculum. The lectures presented shuld cver substantially the same material as the nes printed in this curriculum dcument. An apprpriately qualified clinician will be invlved the develpment and delivery f the curse (they d nt need t be present fr the full duratin f the curse). The live scanning sessins fr this unit shall include sufficient live patient mdels t ensure that each candidate has the pprtunity t scan. Mdels will include nrmal subjects and patients with apprpriate pathlgies. Given that it may be difficult t find subjects with sufficient pathlgy, it is apprpriate t include a practical image interpretatin sessin in which candidates must interpret images f the relevant pathlgy. If the latter are unavailable, there will be at least ne image interpretatin statin with cinelps demnstrating the apprpriate pathlgy. Fr interventinal prcedures, apprpriate phantms may be used. A pst-test will be cnducted at the end f the curse as frmative assessment. Assessment and Lgbk Evidence f satisfactry cmpletin f training sessins Evidence f assessment f cmpetence (summative assessment) signed ff by a suitably qualified assessr (DDU, Radilgist, DMU, CCPU in relevant field). The riginal cmpleted cmpetence assessment frm is t be sent t ASUM with the candidate s cmpleted lg bk.

6 Lgbk requirements need t be cmpleted, and lgbks need t be submitted within tw years f cmpleting an accredited curse. Frmative Assessments At least 2 frmative assessments (directly supervised with suggestins and advice prvided during the scan) Summative Assessment Summative assessment is t be perfrmed by a suitably qualified assessr (see abve) using the cmpetence assessment frm supplied at the end f this dcument (r equivalent if deemed sufficient by ASUM at their discretin). Lgbk Requirements Lgbk requirements need t be cmpleted, and lgbks need t be submitted within tw years f cmpleting an accredited curse. Cmplete 25 examinatins within 2 years f cmpleting a curse: At least 50% f cases shuld shw the Cmmn Bile Duct. At least 5 scans shuld demnstrate gallstnes, and 2 shuld demnstrate Cmmn Bile Duct dilatin (nt necessarily directly supervised but cmpared t gld standard). These shuld be dcumented with electrnic r hard cpy f relevant images. Evidence f cmpletin f lgbk signed ff by a suitably qualified assessr (see abve). At the discretin f the ASUM CCPU Certificatin Bard candidates may be allwed an alternative mechanism t meet this practical requirement. Resurces {Kurtz, 1996 #2} {Rumack, 1998 #1} Prfrma fr Recrding Examinatin Findings (Wrksheet)

7 ASUM is the Peak Bdy fr Medical Ultrasund in Australia and New Zealand ASUM CCPU COMPETENCE ASSESSMENT FORM Biliary Candidate: Assessr: Date: Assessment type: Frmative (feedback & teaching given during assessment fr educatin) Summative (prmpting allwed but teaching nt given during assessment) T pass the summative assessment, the candidate must pass all cmpnents listed Prepare patient Psitin Infrmed Cmpetent Prmpted Fail Prepare Envirnment Lights dimmed if pssible Prbe & Preset Selectin Can change transducer Selects apprpriate transducer Selects apprpriate preset Data Entry Enter patient details Image Acquisitin Optimisatin (depth, freq, fcus, gain) Identifies Liver Prtal vein branches Hepatic veins Diaphragm IVC Hepatrenal space

8 ASUM is the Peak Bdy fr Medical Ultrasund in Australia and New Zealand Biliary system Gall bladder Extra hepatic ducts Intra hepatic ducts Wall thickness Artefacts Describes Appearance f Biliary calculi Appearance f peri-chlecystic fluid Clinical sign f Sngraphic Murphy s Appearance f dilated bile ducts Identifies and explains the basis f cmmn artefacts Recrd Keeping Labels & stres apprpriate images Dcuments any pathlgy identified Cmpletes reprt Each view adequate / inadequate Presence f calculi / absence Dcuments fcussed scan nly Describes findings briefly Integrates ultrasund findings with clinical assessment & explains hw the findings might change management Machine Maintenance Cleans / disinfects ultrasund prbe Stres machine and prbes safely and crrectly Fr Frmative Assessment Only: Feedback f particularly gd areas:

9 ASUM is the Peak Bdy fr Medical Ultrasund in Australia and New Zealand Agreed actins fr develpment: Examiner Signature: Examiner Name: Candidate Signature: Candidate Name: Date: