Thoracic ultrasonography is a readily available, noninvasive imaging method that is useful for pulmonary and critical care specialists. The technique is easy to learn and has 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 other thoracic imaging techniques, such as chest computed tomography (CT) and standard radiography (CXR).
This chapter focuses on use of ultrasonography for diagnosis and management of pleural and lung diseases that are of particular interest to the pulmonary specialist. The chapter is written with the understanding that the pulmonary consultant will personally perform image acquisition, interpret the image, and apply results at the bedside; this is a paradigm that is different from standard thoracic imaging, which requires the pulmonary specialist to rely on the radiology service to acquire and interpret the imaging study. While point-of-care thoracic ultrasonography (POCUS) is advantageous regarding cost and clinical efficiency, it requires acquisition of additional technical skills and knowledge by the pulmonary specialist. An advantage of clinician-performed POCUS is that it couples imaging results with the clinician’s overall knowledge of the case. Thoracic ultrasonography is not performed in isolation; rather, it is combined with other key elements of clinical evaluation, such as the history, physical examination, and laboratory analysis, and it can be performed serially with ease.
TRAINING IN THORACIC ULTRASONOGRAPHY
The goal of thoracic ultrasonography training is to establish clinical competence in performing and interpreting ultrasonographic images. The Statement on Competence in 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 be their 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 to achieve competence in thoracic ultrasonography; several professional societies offer formal training. Compared with the training required in cardiac and abdominal ultrasonography, training in thoracic ultrasonography is more straightforward. The authors have experience in training 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 ultrasonography with several hours of formal teaching. Training should include practice at image acquisition, initially focused on healthy human models and then on patients at the bedside. In addition, training should include the review of a comprehensive image set of normal and abnormal studies, enabling the learner to recognize a wide range of findings when they encounter them at the bedside. The cognitive elements of the field may be learned through reading chapters or review articles.2–4 For more advanced training, comprehensive textbooks are available.5,6 It is useful for the learner to identify a local expert who is able ...