Thoracic ultrasonography is a readily available, noninvasive imaging method that has proved particularly useful for pulmonary and critical care specialists. The technique is easy to learn and engenders multiple applications related to lung and pleural disease. The ease of use and portability of ultrasonography allows physicians to perform point-of-care imaging and reduce dependence on traditional thoracic imaging techniques, such as chest computerized tomography (CT) and standard radiography (CXR).
This chapter focuses on use of ultrasonography for diagnosis and management of pleural and lung diseases and emphasizes those areas that are of particular interest to the pulmonary specialist. Many elements of thoracic ultrasonography that have utility for the pulmonary consultant are also germane to critical care medicine. However, this chapter focuses on the broad context of pulmonary medicine, rather than the elements of thoracic ultrasonography that are specific to critical care. Furthermore, the chapter is written with the assumption that the pulmonary consultant will personally perform image acquisition, interpret the image, and apply results at the bedside—a paradigm that is different from the standard one of thoracic imaging requiring reliance on a radiologist's acquisition and interpretation of the image. While this approach is advantageous with regard to cost and clinical efficiency, it requires technical and cognitive skills. An additional advantage of clinician-performed, point-of-care thoracic ultrasonography is that it couples imaging results with the clinician's overall knowledge of the case. Indeed, thoracic ultrasonography is not performed in vacuo, rather, it is always combined with other key elements of clinical evaluation, such as the history, physical examination, and laboratory analysis. Ultrasonography is an additional tool in the diagnosis and management of pleuropulmonary disease.
Training in Thoracic Ultrasonography
The goal of training in thoracic ultrasonography is, of course, to enable clinical competence in performing the procedure. “Competence” must be defined to facilitate development of specific learning objectives as the goals of training. One pragmatic approach is to establish a reasonable minimum standard for competence. The Statement of Critical Care Ultrasonography provides a well-defined description of training goals in pleural and lung ultrasonography.1 The statement is a good starting point for pulmonary specialists who seek training in the field, and the competencies outlined should constitute the initial learning objectives.
No definitive literature is available to guide the optimal duration of training or the minimal number of studies to be performed and interpreted. No widely accepted course of study for the cognitive elements of the field exists, and, at present there is no formal certification process.
Despite these limitations, many clinicians are competent in thoracic ultrasonography. Compared with the training required in the complex fields of cardiac and abdominal ultrasonography, training in thoracic ultrasonography is straightforward. The authors have considerable experience in training many fellows and attending physicians in thoracic ultrasonography and have found that a motivated learner will achieve skill in the basic elements of pleural and lung ...