Merced, Calif. —
When it comes to
ultrasonography, Dr. Jon Klingborg knows his limitations: ID bladder
stones and not much more, the general practitioner from California says.
That’s because although Klingborg’s practice once spent a small fortune
to acquire a now-outdated machine, handling it and interpreting the
images are two hurdles he says no weekend manufacturer’s course will
serve to improve his competency. Even with 40 patients a day, his
ultrasound caseload is so small that the lack of practice fails to
raise his proficiency, grouping him with general practitioners from the
estimated 20 percent of U.S. practices that have dust collecting on
their ultrasound machines.
“As a profession, we’ve railed against weekend chiropractic and
acupuncture classes, so why should this be any different?” he asks. “It
takes a tremendous amount of practice just to drive the machine, which
makes it extremely challenging here, because I don’t know that we have
one case a day that would call for ultrasonography.”
That’s where Seth Wallack, DVM, Dipl. DACVR, comes in to play. He
thinks all general practitioners should feel comfortable using
ultrasound to recognize and diagnose conditions like chronic
peritonitis and go further to tap the abdomen and put fluid on a slide
to look for bacteria. So the radiologist and part owner of the
Veterinary Imaging Center of San Diego, with the help of several
colleagues, has devised an ultrasonography short course designed to
teach practitioners to recognize and treat the most critical emergency
conditions that plague small-animal patients.
It’s a change to the established, vendor-driven teaching model that
might provide decent ultrasound overviews but offers little to bring
about long-term competency that only comes with years of study and
practice, Wallack says. His advice: Forget about finding adrenal glands
and bowel disease. At a minimum, general practitioners should be able
to recognize critical illnesses in their ultrasound patients.
“There are animals dying out there because a lot of general
practitioners don’t know what they’re seeing when they’re looking at
ultrasound,” he says. “These veterinarians are the first line in
critical cases, and we’re talking about things that will kill an animal
in four hours. They might recognize a problem, but that’s only part of
it. The other parts are management and stabilization, and they should
not have to rely on a me or another specialist to feel comfortable in
The $1,675 program, launched last month, involves two days of
intensive, hands-on training followed by online reading material and an
online exam. A score of 70 percent or better earns the program’s
certification, which Wallack hopes will one day be viewed as legitimate
as standards put forth by the American Animal Hospital Association.
“As a profession, we’re at a similar place to where we once were with
X-ray machines; the prices are coming down and veterinarians are
getting excited to invest in ultrasound,” he says. “But weekend
education, in the past, has led people to buy machines and not use
them. These practitioners are not going to find a centimeter of disease
in a bowel. That’s something that a you learn after three to four years
While Dr. Marty Henderson agrees ultrasound proficiency takes time and
dedication, the general practitioner teaches ultrasound short courses
for Sound Technologies on weekends off from his mobile ultrasound
practice in San Antonio, Texas. He says the two-day training packages
he offers are “extremely in-depth and very well done” and provide users
a solid understanding of the value of ultrasound technology.
“That being said, the bigger issue in my mind is that most of the time
people aren’t going to go home and reproduce what they learned, because
they’re not going to get enough cases or have enough time to get good
at it,” he says.
Henderson, who carries no board certification, spent four years in
general practice before honing in on ultrasound. He says that it took
1,500 cases before he felt competent practicing what he calls “a
completely experience-driven modality.”
“It would take most general practitioners 10 years to get that kind of
experience,” he contends. “There’s a small set of practitioners who
have a machine and use it, but for the most part, they go through a
honeymoon phase after their first year, and then the machine starts to
collect dust. The good thing is that even though they’ve spent the
money and aren’t using the machines to their capacity, they’re
recognizing that there are so many things they could be doing, so the
medicine is better and so is patient care if they refer out or call in
someone with experience."
That idea has helped push ultrasound to become a standard of care in
veterinary medicine, Henderson says. “It’s no longer a pie-in-the-sky
kind of exam. It’s cheaper, it’s easier to get and everyone knows they
need to offer it in their practice, although not everyone has access to
someone who’s good at it.”
And every machine is different, he adds.
“The kids getting out of school think it’s a must-have to do good
medicine. They want to know that the place where they’re working has a
machine, but usually it’s not the $300,000 piece of equipment with a
resident running it that they’re used to having access to,” Henderson
Proficiency takes dedication
Tod Drost, DVM, Dipl. ACVR echoes that sentiment. As an associate
professor in The Ohio State University’s (OSU) Department of Clinical
Sciences and president of the American College of Veterinary Radiology
(ACVR), he contends that scanning all weekend, eight hours a day will
never amount to adequate ultrasound training. The weekend ultrasound
courses provided by vendors rarely feature real cases with sick
animals, he says. And the certifications these courses provide amount
to nothing more than marketing tools used to sell machines because
there’s no concrete definition for “certification.” Without a governing
body policing the term, handing out such documents waters down all
certification processes, including the recognition of specialists,
“For the most part, the public doesn’t know the difference between a
weekend course and a residency program. All they see are documents on
the wall,” he says.
Furthermore, when it comes to practical use, each scan is a 30-minute
to 45-minute procedure that many veterinarians find challenging to
devote to while in general private practice. Ultrasound is in a league
of its own in terms of developing competency, he says.
“You can teach 100 students to interpret radiograph films, and they’ll
be proficient after a semester. Those same 100 students are not going
to learn ultrasound adequately. That’s because ultrasound involves
using the machine, identifying what you’re looking at and going from
there. It’s much more difficult,” Drost says.
To drive that message home, ACVR requires residents to complete at
least six months of concentrated clinical training in diagnostic
ultrasound. And this month, the American College of Veterinary Internal
Medicine reportedly is expected to vote on adding 40 hours of
ultrasound training to its residency requirements.
At OSU’s teaching hospital, Drost says that of the 15,000 imaging cases
that come through each year, a handful stem from missed and incorrect
diagnoses made by private practitioners who misinterpret their own
“Can any DVM become proficient in ultrasound? I think they can. The
thing they need is the time to do the training and someone to help
guide them in practice. The deck is really stacked against private
practitioners. They can’t be all of us rolled into one. That’s just not
realistic,” Drost says.
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email email@example.com.