standards of certification · responsibility of the trainee to ensure that their practical skills...

S T ANDARD S O F C E R T I F I C A T I ON CENTER OF CLINICAL ULTRASOUND (CECLUS)

FACULTY OF HEALTH AARHUS UNIVERSITY

medical science – education – implementation – better patient care

Thomas Fichtner Bendtsen

Lars Bolvig

2012

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Content

0. Introduction ...........................................................................................................................................6 0.1 Background.................................................................................................................................................... 6 0.2 Training Recommendations .................................................................................................................... 7

1. Anaesthesiological ultrasound................................................................................................... 11 1.1 Introduction..................................................................................................................................................11

1a. Anaesthesiological ultrasound – airway .............................................................................. 12 1a.1 Introduction ...............................................................................................................................................12 1a.2 Level 1 ..........................................................................................................................................................13 1a.3 Level 2 ..........................................................................................................................................................17 1a.4 Level 3 ..........................................................................................................................................................18

1b. Anaesthesiological ultrasound - pleura and lung ............................................................ 19 1b.1 Introduction ...............................................................................................................................................19 1b.2 Level 1..........................................................................................................................................................20 1b.3 Level 2..........................................................................................................................................................23 1b.4 Level 3..........................................................................................................................................................25

1c1. Anaesthesiological ultrasound - heart................................................................................ 26 1c1.1 Introduction .............................................................................................................................................26 1c1.2 Level 1 .......................................................................................................................................................27 1c1.3 Level 2 .......................................................................................................................................................32 1c1.4 Level 3 .......................................................................................................................................................35 1c1.5 Maintenance of Skills ..........................................................................................................................35

1c2. Anaesthesiological ultrasound – vascular access ........................................................ 37 1c2.1 Introduction .............................................................................................................................................37 1c2.2 Level 1 .......................................................................................................................................................38 1c2.3 Level 2 .......................................................................................................................................................42 1c2.4 Level 3 .......................................................................................................................................................44 1c2.5 Maintenance of Skills ..........................................................................................................................44

1c3. Anaesthesiological ultrasound – eFAST (extended Focused Assessment with Sonography in Trauma) ...................................................................................................................... 46

1c3. 1 Introduction............................................................................................................................................46 1c3.2 Level 1 .......................................................................................................................................................46 1c3.3 Maintenance of Skills ..........................................................................................................................51

1d. Anaesthesiological ultrasound – nerve blocks ................................................................. 52 1d.1 Introduction ...............................................................................................................................................52 1d.2 Level 1..........................................................................................................................................................53 1d.3 Level 2..........................................................................................................................................................57 1d.4 Level 3..........................................................................................................................................................60

2. Obstetric (fetal medicine) ultrasound ...................................................................................... 61 2.1 Introduction..................................................................................................................................................61 2.2 Level 1 ............................................................................................................................................................62 2.3 Level 2 ............................................................................................................................................................67

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2.4 Level 3 ............................................................................................................................................................69 2.5 Maintenance of skills................................................................................................................................69

3. Gynecological ultrasound............................................................................................................. 70 3.1 Introduction..................................................................................................................................................70 3.2 Level 1 ............................................................................................................................................................71 3.3 Level 2 ............................................................................................................................................................74 3.4 Level 3 ............................................................................................................................................................75 3.5 Maintenance of skills................................................................................................................................76

4. Endocrinological ultrasound ....................................................................................................... 77 4.1 Introduction..................................................................................................................................................77 4.2 Level 1 ............................................................................................................................................................78 4.3 Level 2 ............................................................................................................................................................82 4.4 Level 3 ............................................................................................................................................................83

5. Pediatric ultrasound ........................................................................................................................ 84 5.1 Introduction..................................................................................................................................................84

5c1. Pediatric FATE (focus assessed transthoracic echocardiography) ....................... 85 5c1.1 Introduction .............................................................................................................................................85 5c1.2 Level 1 .......................................................................................................................................................86 5c1.3 Level 2 .......................................................................................................................................................92 5c1.4 Level 3 .......................................................................................................................................................94 5c1.5 Maintenance of skills...........................................................................................................................95

5c2. Pediatric extended FAST (focused assessment with sonography in trauma) ... 96 5c2.1 Introduction .............................................................................................................................................96 5c2.2 Level 1 .......................................................................................................................................................96

5c3. Pediatric ultrasound guided vascular access ...............................................................102 5c3.1 Introduction .......................................................................................................................................... 102

5d. Pediatric neurology ultrasound .............................................................................................109 5d.1 Introduction ............................................................................................................................................ 109 5d.2 Level 1....................................................................................................................................................... 109 5d.3 Maintenance ........................................................................................................................................... 113

6. Oto-rhino-laryngeal ultrasound ................................................................................................114 6.1 Introduction............................................................................................................................................... 114 6.2 Level 1 ......................................................................................................................................................... 115 6.3 Level 2 ......................................................................................................................................................... 120 6.4 Level 3 ......................................................................................................................................................... 121 6.5 Maintenance of skills............................................................................................................................. 121

7. Orthopedic surgery ultrasound ................................................................................................123 7.1 Introduction............................................................................................................................................... 123 7.2 Level 1 ......................................................................................................................................................... 125 7.3 Level 2 ......................................................................................................................................................... 130 7.4 Level 3 ......................................................................................................................................................... 133 7.5 Maintenance of skills............................................................................................................................. 133

8. Rheumatological ultrasound .....................................................................................................135 8.1 Introduction............................................................................................................................................... 135 8.2 Level 1 ......................................................................................................................................................... 137 8.3 Level 2 ......................................................................................................................................................... 142

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8.4 Level 3 ......................................................................................................................................................... 145 8.5 Maintenance of skills............................................................................................................................. 145

9. Infectious Diseases Ultrasound ...............................................................................................146 9.1 Introduction............................................................................................................................................... 146

10. Cardiology.......................................................................................................................................147 10.1 Introduction ............................................................................................................................................ 147 10.2 Level 1 ....................................................................................................................................................... 148 10.3 Level 2 ....................................................................................................................................................... 154 10.4 Level 3 ....................................................................................................................................................... 159 10.5 Maintenance of Skills.......................................................................................................................... 159

11. Lung Medicine Ultrasound .......................................................................................................160 11.1 Introduction ............................................................................................................................................ 160 11.2 Level 1 ....................................................................................................................................................... 161 11.3 Level 2 ....................................................................................................................................................... 164 11.4 Level 3 ....................................................................................................................................................... 166 11.5 Maintenance of skills .......................................................................................................................... 166

12. Ultrasound in Surgical Gastroenterology ..........................................................................167 12.1 Introduction ............................................................................................................................................ 167 12.2 Level 1 ....................................................................................................................................................... 168 12.3 Level 2 ....................................................................................................................................................... 172 12.4 Level 3 ....................................................................................................................................................... 174 12.5 Maintenance of skills .......................................................................................................................... 174

13. Ultrasound of vascular surgery .............................................................................................175 13.1 Introduction ............................................................................................................................................ 175 13.2 Level 1 ....................................................................................................................................................... 176 13.3 Level 2 ....................................................................................................................................................... 180 13.4 Level 3 ....................................................................................................................................................... 182 13.5 Maintenance of skills .......................................................................................................................... 183

14. Ultrasound of neurology ...........................................................................................................184 14.1 Introduction ............................................................................................................................................ 184 14.2 Level 1 ....................................................................................................................................................... 185 14.3 Level 2 ....................................................................................................................................................... 189 14.4 Level 3 ....................................................................................................................................................... 191 14.5 Maintenance of skills .......................................................................................................................... 191

15. Ultrasound of general medicine.............................................................................................192 15.1 Introduction ............................................................................................................................................ 192 15.2 Level 1 ....................................................................................................................................................... 193 15.3 Maintenance of skills .......................................................................................................................... 197

16. Ultrasound of geriatric medicine ...........................................................................................198 16.1 Introduction ............................................................................................................................................ 198 16.2 Level 1 ....................................................................................................................................................... 199 16.3 Maintenance of skills .......................................................................................................................... 203

17. Medical Gastroenterology Ultrasound ................................................................................204 17.1 Introduction ............................................................................................................................................ 204 17.2 Level 1 ....................................................................................................................................................... 205 17.3 Level 2 ....................................................................................................................................................... 209 17.4 Level 3 ....................................................................................................................................................... 211

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17.5 Maintenance of skills .......................................................................................................................... 211 18. Contacts...........................................................................................................................................213

0. Introduction

0.1 Background The increasing applications of ultrasound imaging throughout medical practice, together

with the increasing availability of cheaper and smaller ultrasound scanners, mean that

more medical personnel is using ultrasound equipment to perform and interpret ultrasound

scans.

Ultrasound has an enviable safety record to date. Various bodies, including scientific

societies and manufacturers associations have made recommendations concerning the

safe and prudent operation of ultrasound equipment, but, unlike imaging equipment, which

makes use of ionizing radiation there is virtually no national or international regulation of

ultrasound usage.

The quality of clinical point-of-care (POC) ultrasound depends on the skill of the operator.

To maximize the quality, safety and cost-effectiveness of a clinical ultrasound service and

appropriately address the ethical and legal concerns of inadequately trained ultrasound

operators, the personnel needs to be appropriately trained and to use equipment of

appropriate quality.

An appropriate level of training secures a safe and effective diagnostic, interventional or

clinically focused ultrasound service. However, due to the complexity of issues involved,

few have developed specialized national training schemes for clinical ultrasound and for

instance echocardiography accreditation (through EAE, BSE or the ASE) does not reflect

the requirements of the anesthesiologist and the ICU practitioner, as they contain heavy

emphasis on valvular disease, little haemodynamic monitoring, and an absence of

pathology in the critically ill.

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB)

has proposed minimal training requirements for the practice of medical ultrasound in

Europe.

The hospital and department managements must acknowledge the requirements to deliver

training: the time commitment of the trainer and trainee, the provision of proper budgeting

and funding, the content and practicability of the curriculum and the availability of trainers

and training courses and provision of appropriate space and equipment.

Training should be related to the specialist requirements of the trainee i.e. training should

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be modular. Within any one level of training it may be appropriate for a trainee to become

proficient in some but not all of the individual modules and only undertake ultrasound

practice in this/these areas. Except level one which contains the basic common trunk.

Training should be given in departments which have a multidisciplinary (medical, surgical,

radiological etc) philosophy, an adequate throughput of work, a trainer with experience

and an interest in training in the module required, appropriate equipment and an active

audit process.

Regular appraisal should take place during the training period. At the end of a period of

training a competency assessment form should be completed for each trainee, which will

determine the area or areas in which they can practice independently. The responsibility to

be adequately trained and to maintain those skills lies with the individual practising

ultrasound. An assessment of competence is a reflection on the position at that moment in

time and no more.

Following training, regular and relevant continued medical education (CME)/continued

professional development (CPD) should be undertaken and documented. It is the

responsibility of the trainee to ensure that their practical skills are maintained by ensuring

regular ultrasound clinics are undertaken and that there is an adequate range of pathology

seen in their ultrasound practice.

0.2 Training Recommendations Training should consist of a theoretical module and practical modules of training.

Theoretical Training

Theoretical training should cover the physics of waves, sound waves and ultrasound, and

ultrasound system controlled imaging, ultrasound user controlled imaging, image recording

and reporting, sonographic image artefacts, sonoananatomy, sonopathology, and the

relevance of other imaging modalities to ultrasound. This element of training may be best

achieved by attending formal courses.

Practical Training

A curriculum for each module for the three levels of training has been developed

incorporating a practical syllabus listing conditions which should be included in the

experience of the trainee. In appropriate circumstances, a limited anatomical or modular

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approach may also be acceptable if full competence in that area is demonstrated and

future clinical practice is confined to that area alone. Practical experience should be

gained under the guidance of a named trainer.

The requirements for the different levels of training are as follows:

Level 1

Practice at this level would usually require the following abilities:

a. to perform common examinations safely and accurately

b. to recognize and differentiate normal anatomy and pathology

c. to diagnose common abnormalities within certain organ systems

d. to perform appropriate interventions and clinically focused protocols

e. to recognize when referral for a second opinion is indicated

Within most medical specialties, the training requisite to this level of practice would be

gained during conventional post-graduate specialist training programs.

Different trainees will acquire the necessary skills at different rates and the end-point

of the training program should be judged by an assessment of practical

competence.

Examinations/certification should encompass the full range of diagnostics/pathological

conditions, interventions/procedures and clinically focused protocols listed in the modules.

A log book listing the number and type of examinations undertaken by the trainee

themselves should be kept.

An illustrated log book of specific normal and abnormal findings may be appropriate

for some modules.

Training should usually be supervised by a level 2 practitioner. In certain

circumstances it may be appropriate to delegate some of this supervision to an

experienced level 1 practitioner with at least two years of regular practice.

Level 2

This is an advanced level of practice and requires the following abilities:

a. to accept and manage referrals from Level 1 practitioners

b. to recognize and correctly diagnose almost all pathology within the relevant organ

system

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c. to perform all relevant ultrasound-guided invasive procedures

d. to teach ultrasound to trainees and to Level 1 practitioners

e. to conduct some research in ultrasound

The training requisite to this level of practice would be gained during a period of sub-

specialty training, which may either be within or after the completion of a specialist training

program.

This requires at least one year of experience at level 1 with regular ultrasound

clinics.

A significant further number of examinations should have been undertaken in order to

encompass the full range of conditions and procedures encountered in each module.

A log book listing the numbers and types of examinations undertaken by the trainee

should be maintained.

An illustrated log book of specific normal and abnormal findings is appropriate.

Supervision of training should be undertaken by someone who has achieved at least

level 2 competence and has had at least two years experience at that level.

Level 3

This is an expert level of practice, which involves the following abilities:

a. to accept tertiary referrals from Level 1 and 2 practitioners

b. to perform advanced (level 2) ultrasound examinations

c. to perform advanced (level 2) ultrasound-guided invasive procedures

d. to conduct substantial research in ultrasound

e. to teach ultrasound at all levels

f. to be aware of and to pursue developments in ultrasound

This requires practitioners to spend a significant part of their time undertaking

ultrasound examinations and/or teaching, research and development in the field of

ultrasound.

Continuing Medical Education (CME) and Professional Development (CPD)

The minimum amount of on-going experience in ultrasound as outlined in each

syllabus should be maintained.

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CME/CPD should be undertaken which incorporates elements of ultrasound practice.

Regular audit of the individual’s ultrasound practice should be undertaken to

demonstrate that the indications, performance and diagnostic quality of the service is

satisfactory.

1. Anaesthesiological ultrasound

1.1 Introduction The curriculum of anaesthesiological ultrasound is 3-leveled and modular in order to relate

the training to the specialist requirements of the trainee. Within any level of training it may

be appropriate for a trainee to become proficient in some but not all of the individual

modalities and only undertake ultrasound practice in this/these areas. Except level one

which contains the basic common trunk for all specialists of anaesthesiology.

The modalities of anaesthesiological ultrasound are:

- airway

- pleura/lung

- heart

- vascular access

- eFAST

- nerve blocks

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1a. Anaesthesiological ultrasound – airway

1a.1 Introduction

This curriculum is intended for prespecialists and specialists of anaesthesiology who

perform ultrasound guided Airway Management (UGAM). It includes standards for

theoretical knowledge and practical skills.

Introductory level

Performance of supervised basic UGAM prior to Level 1 certification.

Level 1 (basic)

Performance of unsupervised basic UGAM. Basic UGAM: easy and effective ultrasound

guided exams and procedures for airway management. Basic UGAM certification should

be obtained by all specialists in anaesthesiology. It is recommended that all

anaesthesiologists obtain Level 1 competence, preferably during their specialist training.

At least Level 1 competence should be obtained by anyone performing UGAM

unsupervised.

Level 2 (advanced)

Subspecialized anaesthesiologist who performs basic and advanced UGAM most working

days. Advanced UGAM: all UGAM procedures beyond basic UGAM. Advanced UGRA

certification is typically obtained by specialists in anaesthesiology subspecialized in

anaesthesia for otorhinolaryngology.

Level 3 (expert)

Anaesthesiologists who performs basic and advanced UGAM every working day and most

of the day, and who is active with science and teaching. Only very few anaesthesiologists

obtain expert UGAM level. They are typically employed in a few university hospital

centers.

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Typical progression from Introductory level to Level 3

(1) Course pretest

(2) Theory course of basic UGAM

(3) Theory course posttest

(4) Practical hands-on course of basic UGAM

(2) Course exam in theory and practice of basic UGAM

(3) Supervised procedures of basic UGAM

(4) Level 1 certification of basic UGAM

(5) Unsupervised maintenance of basic UGAM

(6) Theory & practice course of advanced UGAM

(7) Course exam of advanced UGAM

(8) Supervised procedures of advanced UGAM

(9) Level 2 certification of advanced UGAM - theory & practice

(10) Level 3 certification of expert UGAM: Level 2 certified + minimum 500 basic and

advanced UGAM procedures per year for at least two years + teaching experience within

advanced UGAM + minimum three scientific publications about UGAM in peer reviewed

papers (PhD level)

1a.2 Level 1

Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical & Practical

Course

A minimum of 20 hours theoretical and practical teaching is required preferably at the

beginning of the training period. This should include:

Wave, sound wave and ultrasound physics

Ultrasound system controls

Ultrasound user controls

Ultrasound techniques

Ergonomics

Sterility

Safety

Administration (see Appendix 2)

Sonoanatomy

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• Normal airway

o tongue

o thyroid and cricoid cartilages

o cricothyroid membrane

o thyroid rings

o pretracheal soft tissue

• Normal pleura

o lung sliding

o lung pulse

o diaphragm, lever, spleen, vertebral column

Level 1 Competencies to be acquired

To be able to:

• Perform a basic airway US exam • US guided verification of endotracheal intubation • US guided confirmation of endotracheal tube placement • US guided localization of the cricothyroid membrane

• US guided cricothyrotomy • US guided localization of the trachea

Level 1 Theoretical & Practical Course

The course content is equal to the Level 1 knowledge base and the Level 1 competencies

to be acquired listed above. The course should be minimum 20 hours duration at the

beginning of the training period. The theory course should include a pre- and a posttest.

The entire course should be concluded with a course exam covering theory and practice.

The practical sessions should be performed as Hands On Training (HOT):

- HOT 1

o Basic UGAM views on normal models

o Revision of normal findings

- HOT 2

o Basic UGAM views on normal models or patients or sonosimulators

o Revision of pathological findings (tutorial laptops)

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- HOT 3

o Individual reappraisal with interactive in-depth training

The course should be concluded with a course exam in theory and practice of basic

UGAM:

• Theory (30 minutes, 25 MCQ)

• Practice (15 minutes, simulator or model)

Proctored Level 1 practice

• Supervision and recommended number of exams: Within 3 months after the course,

the trainee should collect a minimum of 50 UGAM exams under supervision: 25 fully

supervised basic UGAM exams (TYPE A exams) + 25 autonomously collected (TYPE

B exams, for later validation). The last 25 autonomously performed exams can be

validated either by: a) physical delivery of the electronic logbook + digital clips/images

on a mass storage device (CD/DVD/USB stick) to the assigned tutor once the

collection is completed; b) by internet sharing with a distant tutor. Training should

usually be supervised by a level 2 practitioner. In certain circumstances it may be

appropriate to delegate some of this supervision to an experienced level 1 practitioner

with at least two years of regular practical experience. When local tutors are not

available, the 25 TYPE A exams can be replaced by 25 autonomously collected exams

and internet sharing with a distant tutor where the exams are uploaded and audited

sequentially one-by-one (a dedicated area will be activated on the CECLUS channel,

with reserved access to trainer’s page matched with distance tutor). Lack of information

on single cases, not allowing accurate judgement on trainees competence makes the

case not valid for final certification.

• Documentation: All exams must be video recorded and archived in digital format and

data collected in the electronic logbook (excel file). The documentation should record

time spent, need for supervision and correction, and rating of sonoanatomic skill,

imaging, image quality, and diagnostic performance. During the course of training the

competency assessment sheet should be completed.

• Curriculum: An exam can be a real clinical UGAM exam or a simulated UGAM exam:

Didactic cases (provided from local tutors and from distant tutors) should compensate

for lack of an adequate number of cases on some types of less frequent abnormalities.

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These should not be reported in the logbook but rather listed, indicated separately as

part of exam final documentation. Sequential examinations on the same patients upon

relevant clinical/therapeutical changes are encouraged; provided there’s relevant

change in the findings, they will be counted as individual cases. No more than 10%

exams with normal findings are to be considered for the final certification

Final Level 1 certification of basic UGAM

Different trainees will acquire the necessary skills at different rates and the end point of the

training programme should be judged by an assessment of competencies in the form of

theoretical and practical certification. The theoretical and practical certification should

encompass the full range of the Level 1 knowledge database and competencies to be

acquired listed above.

• Theory (2 hours,100 MCQ)


Areas of competence assessed during certification examination:

• Image generation

• Image acquisition

• Image interpretation

• Image administration

• Clinical and organizational thinking

Tools that may be used for the assessment during certification examination:

• MCQs (overall theoretical assessment)

• Videoclip assessment (assessment of pathological clips interpretation and simulated

clinical integration of findings)

• UGAM exam on a healthy volunteer (assessment of technical skills in machine setting,

image acquisition and storage)

• UGAM on a real patient with relevant morbidity (overall practical assessment)

• Case discussion presented by the trainee

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1a.3 Level 2



programme.

• The training should include a theoretical and practical course of at least 30 hours

(see below) followed by a theoretical and practical examination and the trainee

should read appropriate literature, scientific journals, and textbooks

• Competencies will have been acquired during training for level 1 practice which will

then be refined by performing a minimum of 30 clinic sessions at a centre where

supervision by someone with a Level 2 competence is available.

• Typically a Level 2 practitioner will have undertaken at least 500 ultrasound

examinations within advanced UGAM before Level 2 certification.

• An electronic log book should be kept documenting a minimum of 50 exams which

should include ideally all Level 2 competencies for advanced UGAM. An exam can

be a real clinical UGAM exam or a simulated UGAM exam. A minimum of 25 exams

have to be real clinical UGAM exams. • The theoretical and practical certification should encompass the full range of

procedures listed below.

Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical and

Practical Course

o new ultrasound modalities (eg. 3D and 4D ultrasound)

o advanced sound and ultrasound physics

o advanced ultrasound system machine controls

o advanced ultrasound system user controls

o advanced ultrasound techniques

o advanced administration (teaching, documentation, organization)

o advanced ultrasound artefacts

o advanced UGAM

o airway anatomy and sonoanatomy

o complications

o safety

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o UGRA

o exams of the tongue, oro-pharynx, hypo-pharynx, hyoid bone, larynx, vocal

cords, cricothyroid membrane, cricoid cartilage, trachea, esophagus

o prediction of difficult laryngoscopy in surgical patients

o evaluation of pathology that may influence the choice of airway management

technique (e.g. subglottic hemangiomas, laryngeal stenosis, laryngeal cysts,

respiratory papillomatosis, pharyngeal pouch, various malignancies)

o prediction of the appropriate diameter of endotracheal-, endobronchial-, or

tracheostomy tube

o localization of the trachea

o localization of the cricothyroid membrane

o confirmation of endotracheal tube placement

1a.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking UGAM or

teaching, research and development within their subspecialized field and will be an expert

in this area.

1a.5 Maintenance of Skills

Having been assessed as competent to practice there will be a need for continued

professional development (CPD) and maintenance of practical skills. Recommended

numbers of examinations to be performed annually to maintain skills at each level are

given in the text.

Practitioners should:

• include UGAM in their continued medical education (CME)

• audit their practice

• participate in multidisciplinary meetings

• keep up to date with relevant literature

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1b. Anaesthesiological ultrasound - pleura and lung

1b.1 Introduction

This curriculum is intended for prespecialists and specialists of anesthesiology who

perform lung ultrasound (LUS). It includes standards for theoretical knowledge and

practical skills.

Introductory level

Performance of supervised basic LUS prior to Level 1 certification.

Level 1 (basic)

Performance of unsupervised basic LUS. Basic LUS: easy and effective LUS for

perioperative, emergency and critical care respiratory management. Basic LUS

certification should be obtained by all specialists in anaesthesiology. It is recommended

that all anaesthesiologists obtain Level 1 competence, preferably during their specialist

training. At least Level 1 competence should be obtained by anyone performing basic LUS

unsupervised.

Level 2 (advanced)

Subspecialized anaesthesiologist or critical care specialist who performs basic and

advanced LUS most working days. Advanced LUS certification is typically obtained by

specialists in anaesthesiology or intensive care medicine or lung medicine.

Level 3 (expert)

Expert who performs basic and advanced LUS every working day and most of the day,

and who is active with science and teaching. Only very few clinical specialists obtain

expert LUS level. They are typically employed in a few university hospital centers.

Typical progression from Introduction Level to Level 3

(1) Course pretest

(2) Theory course of basic LUS

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(4) Practical hands-on course of basic LUS

(2) Course exam in theory and practice of basic LUS

(3) Supervised procedures of basic LUS

(4) Level 1 certification of basic LUS

(5) Unsupervised maintenance of basic LUS

(6) Theory & practice course of advanced LUS

(7) Course exam of advanced LUS

(8) Supervised procedures of advanced LUS

(9) Level 2 certification of advanced LUS - theory & practice

(10) Level 3 certification of expert LUS: Level 2 certified + minimum 500 basic and

advanced LUS procedures per year for at least two years + teaching experience within

advanced LUS + minimum three scientific publications about LUS in peer reviewed papers

(PhD level)

1b.2 Level 1


Course

Sound and ultrasound physics

Ultrasound system machine controls

Ultrasound system user controls


Ergonomics

Sterility

Safety


Sonoanatomy

• Normal pleura

o lung sliding

o lung pulse


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Sonopathology

• pneumothorax • pleural effusion


To be able to:

• Perform a basic lung US exam • US guided pleural chest tube insertion







- HOT 1

o Basic LUS views on normal models


- HOT 2

o Basic LUS views on normal models or patients or sonosimulators


- HOT 3


The course should be concluded with a course exam in theory and practice of basic LUS:





the trainee should collect a minimum of 100 LUS exams under supervision: 50 fully

supervised basic LUS exams (TYPE A exams) + 50 autonomously collected (TYPE B

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exams, for later validation). The last 50 autonomously performed exams can be


















• Curriculum: All the above mentioned pathology scenarios should be represented. An

exam can be a real clinical LUS exam or a simulated LUS exam: Didactic cases

(provided from local tutors and from distant tutors) should compensate for lack of an

adequate number of cases on some types of less frequent abnormalities. These should

not be reported in the logbook but rather listed, indicated separately as part of exam

final documentation. Sequential examinations on the same patients upon relevant

clinical/therapeutical changes are encouraged; provided there’s relevant change in the

findings, they will be counted as individual cases. No more than 10% exams with

normal findings are to be considered for the final certification

Final Level 1 certification of basic LUS




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• LUS exam on a healthy volunteer (assessment of technical skills in machine setting,


• LUS on a real patient with relevant morbidity (overall practical assessment)


1b.3 Level 2



programme.







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examinations within advanced LUS before Level 2 certification.


should include ideally all Level 2 competencies for advanced LUS. An exam can be

a real clinical LUS exam or a simulated LUS exam. A minimum of 25 exams have to

be real clinical LUS exams. • The theoretical and practical certification should encompass the full range of



Practical Course

o new ultrasound modalities (eg. image fusion and 4D ultrasound)







o advanced LUS

o anatomy and sonoanatomy

o pathology and sonopathology

o complications

o safety


o LUS

o diagnose pneumothorax

o diagnose pleural effusion

o diagnose rib fractures

o diagnose interstitial syndrome

o diagnose lung edema

o diagnose ARDS

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o diagnose interstitial lung disease

o diagnose respiratory distress syndrome

o diagnose lung consolidation

o diagnose pneumonia

o diagnose lung embolus

o diagnose lung tumour

o diagnose atelectasis (compression, obstruction)

o examination of acute, severe respiratory insufficiency with the BLUE

(Bedside Lung Ultrasound in Emergency) protocol

o control of lung ventilation after intubation

1b.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking LUS or


in this area.

1b.5 Maintenance of Skills



numbers of examinations to be performed annually to maintain skills at each level

Level 1: the practitioner should perform at least 100 basic LUS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced LUS exams each

year.

Level 3: the practitioner should perform at least 400 basic and advanced LUS exams each

year.


• include LUS in their continued medical education (CME)




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1c1. Anaesthesiological ultrasound - heart

1c1.1 Introduction

This curriculum is intended for CECLUS certification Level 1-3 of prespecialists and

specialists of anaesthesiology who perform focused cardiac ultrasound – also called FATE

(focus assessed transthoracic echocardiography). The FATE curriculum includes

standards for theoretical knowledge and practical skills.

Introductory level (pre-certification)

Performance of supervised basic FATE prior to Level 1 certification.

Level 1 (basic) certification

Performance of unsupervised basic FATE. Basic FATE is easy and effective basic

assessment of haemodynamics with ultrasound. Basic FATE certification should be

obtained by all clinical specialists assessing potentially acute or critically ill patients. It is

especially recommended that all anaesthesiologists obtain Level 1 FATE competence,

preferably prior to or during their specialist training. At least Level 1 competence should be

obtained by anyone performing basic FATE unsupervised.

Level 2 (advanced) certification

Subspecialized clinical specialist who performs focused cardiac assessment with

ultrasound most working days. Advanced FATE is typically obtained by specialists in

anaesthesiology subspecialized in anaesthesia for cardiothoracic surgery or intensive care

medicine or emergency medicine.

Level 3 (expert) certification

Clinical specialists who perform basic and advanced FATE every working day and most of

the day, and who are active with FATE related science and teaching. Only very few clinical

specialists employing FATE obtain the expert FATE level 3 certification. They are typically

employed in university hospital centers.

27


(1) Theory course pretest

(2) Theory course of basic FATE


(4) Practical hands-on course of basic FATE

(2) Course exam in theory and practice of basic FATE

(3) Proctored practice (supervised procedures) of basic FATE

(4) Level 1 certification of basic FATE

(5) Unsupervised maintenance of basic FATE

(6) Theory & practice course of advanced FATE

(7) Course exam of advanced FATE

(8) Supervised procedures of advanced FATE

(9) Level 2 certification of advanced FATE - theory & practice

(10) Level 3 certification of expert FATE: Level 2 certified + minimum 500 basic and

advanced FATE exams per year for at least two years + teaching experience within

advanced FATE + minimum three FATE related scientific publications in peer reviewed

papers (PhD level)

1c1.2 Level 1


Course

Wave, sound and ultrasound physics




- B mode (2D brightness mode)

- M mode (motion mode)

- Power Doppler

- Pulsed wave Doppler

- Continous wave Doppler

Ergonomics

28

Sterility

Safety

Administration

• Implementation of a focused echocardiography program

Sonoanatomy

• basic TTE (transthoracic echocardiography) 2D views

o subcostal 4-chamber

o apical 4-chamber

o parasternal long axis

o parasternal short axis at the following levels:

aortic valve (base)

mitral leaflet tips

papillary muscles

Cardiac function

systolic ventricular function

diastolic ventricular function

ejection fraction

fractional shortening

mitral septal separation

mitral annular plane systolic excursion (MAPSE)

tricuspid annular plane systolic excursion (TAPSE)

LV dimensions (2D and M-mode)

• Septal thickness at end diastole

• Cavity size at the end diastole

• Posterior wall thickness at end diastole

• Cavity size at end systole

Aortic root dimension

Left atrial dimension

Sonopathology

• Basic cardiac chamber dysfunction

o dilated left atrium o dilated left ventricle

29

o dilated right atrium

o dilated right ventricle o hypertrophy left ventricle

• Mesothelial cavities o pericardial effusion

basic US diagnosis of cardiac tamponade US guided pericardiocentesis

• Pedunculated masses

• Endocarditis and the valves

• Hypovolemia


To be able to perform a basic FATE exam:

• Perform echocardiographic examinations safely and accurately and acquire all

standard views • To recognise and differentiate between normal anatomy/physiology and pathology • To diagnose common abnormalities within the cardiovascular system

• To recognize when a referral for a second opinion is indicated • To understand the relationship between echocardiographic imaging and other

diagnostic imaging techniques • Perform focused point-of-care echocardiographic hemodynamic monitoring of

patient response to interventions and diagnostics:

o Ventricular function Systolic function and wall motion abnormalities Diastolic function

o Hypovolemia and volume responsiveness

o Tamponade and pericardial disease o The sepsis syndromes o Effects of preload and afterload and assessment of filling status o Acute cor pulmonale

o Hypoxemia o Complications of acute MI

30

o Chest trauma

o Assessment of shock o Peri-resuscitation o Failure to wean from mechanical ventilation o Hemodynamic measurements





The entire course should be concluded with a course exam covering theory and practice.¨


- HOT 1

o Basic TTE views on normal models


- HOT 2

o Basic TTE views on normal models or patients or sonosimulators


- HOT 3

- Individual reappraisal with interactive in-depth training

The course should be concluded with a course exam in theory and practice of basic FATE:





the trainee should collect a minimum of 25 basic FATE exams under supervision: 25

fully supervised basic FATE exams (TYPE A exams) + 25 autonomously collected

(TYPE B exams, for later validation). The last 25 autonomously performed exams can

be validated either by: a) physical delivery of the electronic logbook + digital

clips/images on a mass storage device (CD/DVD/USB stick) to the assigned tutor once

the collection is completed; b) by internet sharing with a distant tutor. Training should

31
















exam can be a real clinical UVS exam or a simulated UVS exam: Didactic cases







normal findings are to be considered for the final certification.

Final Level 1 certification of basic FATE








32

Areas of competence assessed during examination:






Tools that may be used for the assessment during examination:




• TTE on a healthy volunteer (assessment of technical skills in machine setting, image

acquisition and storage)

• TTE on a real critical or cardially morbid patient (overall practical assessment,

including ECHO-guided patient management)


1c1.3 Level 2


Practical Course

o new ultrasound modalities (eg. 4D ultrasound and image fusion)

o contrast agents







o advanced FATE:

o systolic function

preload (Frank-Starling's law)

afterload (LaPlace's law)

33

contractility (intrinsic myocardial function)

ejection fraction (eyeballing, calculation with M-mode)

hemodynamic parameters (cardiac output (CO) with pulsed wave

Doppler (PWD))

o diastolic function

compliance and relaxation of the left ventricle using transmitral flow

curve visualized with PWD

estimating inotropic effect and/or volume effect

o pericardial effusion

o pleural effusion

o pathology (lung embolus, acute coronary syndrome, papillary muscle

rupture, septic shock, chest trauma, complicated AMI, cardiac tamponade,

pulmonary oedema (cardiogenic and non-cardiogenic), weaning failure from

mechanical ventilation, ARDS, acute valvular dysfunction)

o valvular stenosis using pressure gradients (continuous wave Doppler - CWD)

o insufficiency jets (valvular insufficiency) and atrial septal defect and

ventricular septal defect using colour flow Doppler (CFD)

o assessment of wall thickness and chamber dimensions in M-mode

o assessment of bi-ventricular function

o application of extended FATE views

subcostal vena cava

apical 2-chamber view

apical long-axis view


parasternal short axis mitral plane view

parasternal aorta short axis view

o diastolic left ventricular function

o Doppler (continuous wave, pulsed wave)

o Measurement of cardiac filling pressures

o Measurement of cardiac output and pulmonary artery pressure

34


Competencies will have been gained during training for Level 1 practice and then refined

during a period of practice

To be able to:

o advanced FATE

o perform the advanced FATE protocol

o estimate chamber dimensions and left ventricular diameter (M-mode)

o estimated contractility (systolic function) of both ventricles

o estimate fractional shortening (FS) and ejection fraction (EF) with M-mode of

the left ventricle

o estimated cardiac output of left ventricle with continuous wave Doppler

o gauge mitral annular plane systolic excursion (MAPSE)

o gauge mitral septal separation (MSS)

o gauge tricuspid annular plane systolic excursion (TAPSE)

o visualize transmitral flow with PWD

o identify important pathology, e.g. left ventricular dilatation, left ventricular

hypertrophy, hypovolemia, left atrial dilatation, right ventricular dilatation,

pericardial effusion, pleural effusion, anatomical defects.

o detect valvular stenosis and/or insufficiency using CWD and CFD.

o correlate sonographic findings to clinical context.

o Color Doppler mapping

o Quantitative spectral Doppler

Pulsed Doppler

Continous wave Doppler

o TDI (Tissue Doppler Imaging)

The training should include a theoretical and practical course of at least 30 hours (see

below) followed by a theoretical and practical examination and the trainee should read

appropriate literature, scientific journals, and textbooks


then be refined by performing a minimum of 30 clinical sessions at a centre where


35


examinations within advanced FATE before Level 2 certification.

• An electronic log book should be kept documenting a minimum of 50 procedures

which should include ideally all Level 2 competencies for advanced FATE.

• The theoretical and practical certification should encompass the full range of

sonopathology listed above.

1c1.4 Level 3

A Level 3 practioner is likely to spend the majority of their time undertaking FATE or


in this area.

1c1.5 Maintenance of Skills




Level 1: the practitioner should perform at least 100 basic UVS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced UVS exams each

year.


year.


• include FATE in their continued medical education (CME)




36

Certification for physicians already holding national/international TTE certifications

Physicians holding national or international echocardiography accreditation are considered

technically competent in the execution of a Focused Echo exam. Their clinical competence

in image integration into the critical or acute cardiac patient management should though

be certified by provision of minimum 30 documented exams (Logbook) + exam on a critical

patient + case discussion

1c2. Anaesthesiological ultrasound – vascular access 1c2.1 Introduction

This curriculum is intended for CECLUS certification Level 1-3 of prespecialist and

specialist anesthesiologists who perform ultrasound guided vascular access (UGVA).

UGVA includes standards for theoretical knowledge and practical skills.


Performance of supervised basic UGVA prior to Level 1 certification.

Level 1 (basic) UGVA certification

Performance of unsupervised basic UGVA. Basic UGVA certification should be obtained

by all specialists of anesthesiology, preferably prior to or during their specialist training. At

least Level 1 competence should be obtained by anyone performing basic UGVA

unsupervised.

Level 2 (advanced) UGVA certification

Subspecialized specialist of anaesthesiology who performs basic and advanced UGVA

most working days.

Level 3 (expert) UGVA certification

Subspecialized experts of anaesthesiology who perform basic and advanced UGVA every

working day, and who are active with UGVA related science and teaching. Only very few

anaesthesiologists employing UGVA obtain the expert UGVA level 3 certification – if any.

They would typically be employed in a few university hospital centers.

Typical progression from introductory level to Level 3


(2) Theory course of basic UGVA


(4) Practical hands-on course of basic UGVA

38

(2) Course exam in theory and practice of basic UGVA

(3) Proctored practice (supervised procedures) of basic UGVA

(4) Level 1 certification of basic UGVA

(5Unsupervised maintenance of basic UGVA

(6) Theory & practice course of advanced UGVA

(7) Course exam of advanced UGVA

(8) Supervised procedures of advanced UGVA

(9) Level 2 certification of advanced UGVA - theory & practice

(10) Level 3 certification of expert UGVA: Level 2 certified + minimum 300 basic and

advanced UGVA exams per year for at least two years + teaching experience within

advanced UGVA + minimum three UGVA related scientific publications in peer reviewed

papers (PhD level)

1c2.2 Level 1


Course



Ultrasound system user controls (knobbology)



- Doppler (color)

- In-plane/out-of-plane

Ergonomics

Sterility

Safety

Administration

• Implementation of an UGVA program

Sonoanatomy

• Superficial cubital and antebrachial veins

• Brachial veins

39

• Major saphenous vein

• Femoral vein

• Internal jugular vein

• Subclavian vein/axillary vein

• Radial artery

• Femoral artery

Sonopathology

• Thrombosis

• Complications

Pitfalls and limitations


To be able to perform basic UGVA:

• Perform UGVA safely and accurately • To recognise and differentiate between normal anatomy/physiology and pathology • To recognize when a referral for a second opinion is indicated







- HOT 1

o Basic UGVA views on normal models


- HOT 2

o Basic UGVA views on normal models or patients or sonosimulators


- HOT 3


40

Level 1 theoretical and practical course exam on basic UGVA



The course should be concluded with a course exam in theory and practice of basic UVS:





the trainee should collect a minimum of 50 UGVA exams under supervision: 25 fully

supervised basic UGVA exams (TYPE A exams) + 25 autonomously collected (TYPE



• on a mass storage device (CD/DVD/USB stick) to the assigned tutor once the

















exam can be a real clinical UGVA exam or a simulated UGVA exam: Didactic cases



41






Final Level 1 certification of basic UGVA








Areas of competence assessed during examination






Tools that may be used for the assessment during examination




• UGVA imaging on a healthy volunteer (assessment of technical skills in machine

setting, image acquisition and storage)


42

1c2.3 Level 2



programme.








examinations within advanced UGVA before Level 2 certification.


which should include ideally all Level 2 competencies for advanced UGVA.

• To maintain competence at Level 2 practitioners should perform at least 50

advanced UGVA each year.


Practical Course

o advanced sound and ultrasound physics (eg. 3D ultrasound and image fusion)






o advanced UGVA:

o Central venous catheters

Umbilical vein catheter

Femoral vein catheter

Subclavian vein catheter

o Umbilical artery catheter

43

o Radial artery catheter


o perform the advanced UGVA procedures

o apply color Doppler

A minimum of 30 hours theoretical and practical teaching is required. Prior to the theory

course the practitioner performs a pretest. The theory course should be concluded with a

posttest with a minimum level of performance before entering the practical hands-on

course.

1c2.4 Level 3

A level 3 practioner is likely to spend a substantial amount of their time undertaking UGVA

and teaching, research and development within their subspecialized field and will be an

expert in this area.




numbers of procedures to be performed annually to maintain skills at each level are given

in the text.


• include UGVA in their continued medical education (CME)




Maintenance requirements




Level 1: the practitioner should perform at least 50 basic UGVA exams each year.

Level 2: the practitioner should perform at least 100 basic and advanced UGVA exams

each year.

Level 3: the practitioner should perform at least 200 basic and advanced UGVA exams

each year.

Certification for physicians already holding national/international UGVA certifications

Physicians holding national or international UGVA accreditation are considered technically

competent in the execution of basic UGVA. Their clinical competence in UGVA should

45

though be certified by provision of minimum 5 documented exams (Logbook) + exam on a

model + case discussion.

1c3. Anaesthesiological ultrasound – eFAST (extended Focused Assessment with Sonography in Trauma) 1c3. 1 Introduction This protocol is intended for CECLUS certification Level 1 of prespecialists and specialists

of anaesthesiology who perform focused assessment with sonography in trauma – also

called FAST. The FAST protocol includes standards for theoretical knowledge and

practical skills.

The extended version of FAST (eFAST) is presented which includes assessment of:

- pleural effusion

- pericardial effusion

- peritoneal effusion

- abdominal aorta

- inferior vena cava

- urinary bladder

Typical progression to eFAST certification


(2) Theory course of eFAST


(4) Practical hands-on course of eFAST

(2) Course exam in theory and practice of eFAST

(3) Proctored practice (supervised procedures) of eFAST

(4) Certification of eFAST - theory (30 minutes, 25 MCQ) & practice (15 minutes, simulator

or model)

(5) Unsupervised maintenance of eFAST

1c3.2 Level 1

Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical & Practical Course


47






Ergonomics

Sterility

Safety

Administration

• Implementation of an eFAST program

Sonoanatomy

• eFAST 2D and M-mode views

o Pleura

Anterior, bilateral

Posterior, bilateral

o Pericardium

o Peritoneum

Liver/right kidney

Spleen/left kidney

Rectovesical/vesicouterine pouch

Urinary bladder

Abdominal aorta

Inferior vena cava

Sonopathology

• Pneumothorax

• Pleura effusion • Cardiac tamponade • Peritoneal effusion • Distended urinary bladder

• Abdominal aortic enlargement • Hypovolemia

48

eFAST Competencies to be acquired

To be able to perform an eFAST exam:

• Perform the eFAST examinations safely and accurately and acquire all standard

views • To recognise and differentiate between normal anatomy/physiology and pathology

• To diagnose common abnormalities • To recognize when a referral for a second opinion is indicated • To understand the relationship between ultrasound imaging and other diagnostic

imaging techniques







- HOT 1

o eFAST views on normal models


- HOT 2

o eFAST views on normal models or patients or sonosimulators


- HOT 3





• Proctored eFAST practice


the trainee should collect a minimum of 25 fully supervised eFAST exams (TYPE A

49

exams) + 25 autonomously collected (TYPE B exams, for later validation). All exams

must be archived in digital format and data collected in the logbook (excel file).

• When local tutors are not available, for the 25 fully supervised exams the 5 TYPE A

exams can be replaced by 25 autonomously collected exams and internet sharing with

a distant tutor where the exams are uploaded and audited sequentially one-by-one (a

dedicated area will be activated on the CECLUS channel, with reserved access to the

trainees page matched with distance tutor). Lack of information on single cases, not

allowing accurate judgement on trainees competence makes the case not valid for final

certification.















• The last 25 autonomously performed exams can be validated either by: a) physical

delivery of logbook + digital clips/images on a mass storage device (CD/DVD/USB

stick) to the assigned tutor once the collection is completed; b) by internet sharing with

a distant tutor (see above). The FAST exams should be preferrably performed in

patients with pathological hemodynamics.

• Case mix should include: Pneumothorax, pleura effusion, cardiac tamponade,

peritoneal effusion, distended urinary bladder, abdominal aortic enlargement, and

hypovolemia.

50

• Didactic cases (provided from local tutors and from distant tutors) should compensate





change in the findings, they will be counted as individual cases.

• No more than 10% exams with normal findings are to be considered for the final

certification

Final Level 1 certification of basic UVS


















• eFAST on a healthy volunteer (assessment of technical skills in machine setting, image


51

• eFAST on a real patient (overall practical assessment, including FAST-guided patient

management)






Level 1: the practitioner should perform at least 100 eFAST exams each year.


• include eFAT in their continued medical education (CME)




1d. Anaesthesiological ultrasound – nerve blocks

1d.1 Introduction

This curriculum is intended for CECLUS certification Level 1-3 of pre-specialists and

specialists of anaesthesiology who perform ultrasound guided regional anaesthesia

(UGRA). It includes standards for theoretical knowledge and practical skills.

Introductory level

Performance of supervised basic UGRA prior to Level 1 certification.

Level 1 (basic)

Performance of unsupervised basic UGRA. Basic UGRA is easy and effective single shot

peripheral nerve blocks for perioperative, emergency and critical care analgesia -

interscalene, infraclavicular, femoral, popliteal sciatic, and TAP blocks. Basic UGRA

certification should be obtained by all specialists in anaesthesiology. It is recommended

that all anaesthesiologists obtain Level 1 competence, preferably during their specialist

training. At least Level 1 competence should be obtained by anyone performing UGRA

unsupervised.

Level 2 (advanced)

Subspecialized anaesthesiologists who perform basic and advanced nerve blocks most

working days. Advanced UGRA: all single shot peripheral nerve blocks beyond basic

blocks, all continuous nerve blocks with catheter technique, and neuraxial UGRA.

Advanced UGRA certification is typically obtained by specialists in anaesthesiology

subspecialized in orthopedic surgery anaesthesiology.

Level 3 (expert)

Anesthesiologists who perform basic and advanced UGRA every working day and most of

the day, and who is active with science and teaching. Only very few anaesthesiologists

obtain expert UGRA level. They are typically employed in university hospital centers.

53



(2) Theory course of basic UGRA


(4) Practical hands-on course of basic UGRA

(2) Course exam in theory and practice of basic UGRA

(3) Supervised procedures of basic UGRA

(4) Level 1 certification of basic UGRA

(5) Unsupervised maintenance of basic UGRA

(6) Theory & practice course of advanced UGRA

(7) Course exam of advanced UGRA

(8) Supervised procedures of advanced UGRA

(9) Level 2 certification of advanced UGRA - theory & practice

(10) Level 3 certification of expert UGRA: Level 2 certified + minimum 500 basic and

advanced UGRA procedures per year for at least two years + teaching experience within

advanced UGRA + minimum three scientific publications about UGRA in peer reviewed

papers (PhD level)

1d.2 Level 1


Course





Ergonomics

Sterility

Safety


Sonoanatomy

• Normal peripheral nerves

54

o cervical plexus

o brachial plexus

spinal nerve roots

trunks

transition zone

fascicles

terminal nerves

• radial nerve

• median nerve

• ulnar nerve

• musculocutaneous nerve

o lumbar plexus

femoral nerve, inguinal crease

• saphenous nerve, adductor canal

obturator nerve

• anterior branch

• posterior branch

lateral femoral cutaneous nerve

o sacral plexus

sciatic nerve

sciatic nerve, popliteal fossa

tibial nerve, popliteal fossa

common peroneal nerve, popliteal fossa

o trunkal innervation

Specific nerve blocks: Imaging, image recognition (still images and video clips), needle

dexterity

• interscalene brachial plexus block • infraclavicular brachial plexus block • femoral nerve block including saphenuous nerve block

• popliteal sciatic nerve block • transverse abdominis plane (TAP) block

55


To be able to:

• Perform the five nerve blocks in basic UGRA o interscalene brachial plexus block o infraclavicular brachial plexus block

o femoral nerve block including saphenuous nerve block o popliteal sciatic nerve block o transverse abdominis plane (TAP) block







- HOT 1

o interscalene block

- HOT 2

o infraclavicular block

- HOT 3

o femoral nerve block (incl. saphenous block)

- HOT 4

o popliteal sciatic nerve block

- HOT 5

o TAP block

- HOT 6

o needle dexterity training in phantoms


UGRA:



56



the trainee should collect a minimum of 100 UGRA exams under supervision: 50 fully

supervised basic UGRA exams (TYPE A exams) + 50 autonomously collected (TYPE




















exam can be a real clinical UGRA exam or a simulated UGRA exam: Didactic cases








57

Final Level 1 certification of basic UGRA


















• UGRA exam on a healthy volunteer (assessment of technical skills in machine setting,



1d.3 Level 2



programme.




58




• Typically a Level 2 practitioner will have undertaken at least 2.000 ultrasound

examinations within advanced ultrasound guided regional anaesthesia (UGRA)

before Level 2 certification.


which should include ideally all Level 2 competencies for advanced UGRA. A

procedure can be a real clinical UGRA procedure or a simulated UGRA procedure.

A minimum of 25 procedures have to be real clinical UGRA procedures. • The theoretical and practical certification should encompass the full range of


• To maintain competence at Level 2 practitioners should perform at least 500 clinical

examinations each year within their Level 2 subspecialty of advanced UGRA. Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical and

Practical Course

o new ultrasound modalities (eg. 4D ultrasound, biplane ultrasound and image fusion)

o contrast agents







o advanced UGRA


o peripheral nerve pathology

o neurophysiology and neuropathophysiology

o complications

o safety

o histology of peripheral nerves

59

o pharmacology of local anaesthetics and adjuvants

o peripheral nerve stimulators and electrophysiology

o continuous nerve blocks

o UGRA in children


o UGRA

o US guided insertion of catheters for continuous peripheral nerve blockade

(subspecialty: orthopedic surgery anaesthesia - OSA)

o trigeminal (Gasserian) nerve block (subspecialty: neuroanaesthesia - NA)

o occipital nerve block (subspecialty: NA)

o cervical plexus block (superficial, deep) (subspecialty: OSA)

o suprascapular nerve block (subspecialty: OSA)

o supraclavicular brachial plexus block (subspecialty: OSA)

o axillary brachial plexus block (subspecialty: OSA)

o lumbar plexus block (subspecialty: OSA)

o fascia transversalis block (subspecialty: OSA)

o quadratus lumborum block (subspecialty: OSA)

o obturator nerve block (anterior and posterior branch) (subspecialty: OSA)

o lateral femoral cutaneous nerve block (subspecialty: OSA)

o genitofemoral nerve block (femoral branch) (subspecialty: OSA)

o sacral plexus block (subspecialty: OSA)

o sciatic nerve block (transgluteal, subgluteal, anterior approach)

(subspecialty: OSA)

o posterior tibial nerve block, ankle (subspecialty: OSA)

o sural nerve block, ankle (subspecialty: OSA)

o superficial peroneal nerve, ankle (subspecialty: OSA)

o deep peroneal nerve, ankle (subspecialty: OSA)

o intercostal block (subspecialty: OSA)

o spinal anaesthesia (subspecialty: OSA)

o caudal anaesthesia (subspecialty: OSA)

o combined spinal-epidural anaesthesia (subspecialty: OSA)

60

o epidural blockade (cervical, thoracic, lumbar) (subspecialty: gastroenterology

anaesthesia - GEA, OSA)

o thoracic paravertebral block (subspecialty: GEA)

o iliohypogastric/ilioinguinal block (subspecialty: GEA)

o stellate ganglion block (subspecialty: pain medicine)

o ganglion impar block (subspecialty: pain medicine)

o facet joint block (subspecialty: pain medicine)

1d.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking UGRA or


in this area.

1d.5 Maintenance of Skills




given in the text.

Recommended numbers of examinations to be performed annually to maintain skills at

each level

Level 1: the practitioner should perform at least 100 basic UGRA exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced UGRA exams

each year.

Level 3: the practitioner should perform at least 400 basic and advanced UGRA exams

each year.


• include UGRA in their continued medical education (CME)




2. Obstetric (fetal medicine) ultrasound

2.1 Introduction DSOG (Dansk Selskab for Obstetrik og Gynækologi = the Danish Society of Obstetrics

and Gynecology) has established a system of education and certification for fetal medicine

ultrasound (FMU) that is mandatory for all Danish practioners of FMU.


specialists of obstetrics who perform fetal medicine ultrasound (FMU). The curriculum

includes standards for theoretical knowledge and practical skills.


Performance of supervised basic FMU prior to Level 1 certification. All trainees of

gynecology and obstetrics in Denmark complete 3 weeks (1+2) of supervised focused

FMU in the departments of Fetal Medicine of the university hospitals.


Performance of unsupervised basic FMU. Basic FMU is easy and effective basic

assessment of basic fetal medicine conditions with ultrasound. Basic FMU certification

should be obtained by all specialists of obstetrics. At least Level 1 competence should be

obtained by anyone performing basic FMU unsupervised.


Subspecialized specialists who perform advanced FMU most working days. Level 2

certification is only obtained by few specialists of obstetrics.


Subspecialized experts who perform advanced FMU every working day and most of the

day, and who are active with FMU related science and teaching. Only very few clinical

experts employing FMU obtain the expert FMU level 3 certification. They are typically


62

Typical progression from introductory level to Level 3


(2) Theory course of basic FMU


(4) Practical hands-on course of basic FMU

(2) Course exam in theory and practice of basic FMU

(3) Proctored practice (supervised procedures) of basic FMU

(4) Level 1 certification of basic FMU

(5) Unsupervised maintenance of basic FMU

(6) Theory & practice course of advanced FMU

(7) Course exam of advanced FMU

(8) Supervised procedures of advanced FMU

(9) Level 2 certification of advanced FMU - theory & practice

(10) Level 3 certification of expert FMU: Level 2 certified + minimum 400 advanced FMU

exams per year for at least two years + teaching experience within advanced FMU +

minimum three FMU related scientific publications in peer reviewed papers (PhD level)

2.2 Level 1 Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical & Practical

Course





Ergonomics

Sterility

Safety

Administration

Sonoanatomy (including common variants)

• estimation of date of pregnancy

• estimation of the weight and growth of the fetus

63

• Normal fetal anatomy

• Multiple pregnancy

• Placenta, amniotic fluid

Sonopathology (pathology and results of treatment in relation to ultrasound)

• common fetal malformations

• Screening for fetal chromosomal aberrations – eg. nuchal fold scans


To be able to:

General

• systematics (abdominal/vaginal)

• image optimization

• cleaning the ultrasound system

Scan

• gestational sac

• CRL

• BPD

• head structure

• insertion site

• extremities

• estimation of due date

• missed abortion counselling

Nuchal fold scans

• nuchal fold

• nasal bone

• gastric ventricle

• urinary bladder

• risc counselling

Counselling of increased risk of combination tests

• counselling about big nuchal fold

• counselling about chorionic villus sampling and amniocentesis

64

Scans of malformations

• BPD

• cerebral structures

• thorax/abdomen – position of cor and gastric ventricle

• 4 chamber view of the heart

• gastric ventricle

• abdominal wall

• renal pelvis and bladder

• limbs

• sex determination

• position of placenta

• profile/photo

• Down stigmata

• normal MD

• counselling about placenta previa

• common malformations

• counselling about common malformations

3. semester scans

• weight • fluid • flow (umbilicus) • flow (cerebri media artery)

• cervix scan • counselling about short cervix • estimation of the state of the fetus • general overview of the status of the fetus

Gemelli

• classification 1/2 a/b

• classification of choriosity

• monochoric gemelli

• dichoric gemelli

• deepest sea

65

• weight

• flow

• TTTS







- HOT 1

o Basic FMU views on normal non-pregnant models


- HOT 2

o Basic UVS views on normal non-pregnant models or pregnant women or

sonosimulators


- HOT 3



FMU:





the trainee should collect a minimum of 400 FMU exams under supervision: 200 fully

supervised basic FMU exams (TYPE A exams) + 200 autonomously collected (TYPE B





66




available, the 200 TYPE A exams can be replaced by 200 autonomously collected

exams and internet sharing with a distant tutor where the exams are uploaded and

audited sequentially one-by-one (a dedicated area will be activated on the CECLUS

channel, with reserved access to trainer’s page matched with distance tutor). Lack of

information on single cases, not allowing accurate judgement on trainees competence

makes the case not valid for final certification.







exam can be a real clinical FMU exam or a simulated FMU exam: Didactic cases








Final Level 1 certification of basic FMU








67











• FMU exam on a healthy volunteer (assessment of technical skills in machine setting,


• FMU on a real pregnant woman or patient with relevant morbidity (overall practical

assessment)


2.3 Level 2



programme.








examinations within basic and advanced FMU before Level 2 certification.

68


should include ideally all Level 2 competencies for advanced FMU. An exam can be

a real clinical FMU exam or a simulated FMU exam. A minimum of 25 exams have

to be real clinical FMU exams. • The theoretical and practical certification should encompass the full range of



Practical Course

o new ultrasound modalities (eg. 4D ultrasound, MRI and image fusion)





o fetal echocardiography

o fetal Doppler

o soft markers



o advanced sonoanatomy (including common variants)

o advanced UVS sonopathology (pathology and results of treatment in relation to

ultrasound)

o fetal malformations

o syndromes

o complications

o safety

Level 2 competencies to be acquired



To be able to:

• perform a complete imaging ultrasound scan and identify all abnormalities detailed

69

in Level 1

• diagnose all fetal malformations and knowledge about the treatment

• diagnose intrauterine growth inhibition and knowledge about treatment

• diagnose complications related to twin pregnancy and knowledge about treatment

2.4 Level 3

A Level 3 practioner is likely to spend the majority of their time undertaking advanced FMU


expert in this area. A Level 3 practitioner will accept tertiary referrals from Level 1 and 2

practioners. He/she should have the capability to utilise developing technologies and

ultrasound techniques, develop research and teaching skills and the performance of

specialised examinations including the use ultrasound guided interventional procedures.

DSOG has established an expert education of fetal medicine leading to Level 3 in FMU.

2.5 Maintenance of skills




Level 1: the practitioner should perform at least 400 basic FMU exams each year.

Level 2: the practitioner should perform at least 800 basic and advanced FMU exams each

year.

Level 3: the practitioner should perform at least 1.200 basic and advanced FMU exams

each year.


• include FMU in their continued medical education (CME)




3. Gynecological ultrasound

3.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pre-specialists and

specialists of vascular surgery who perform gynecological ultrasound (GUS). The

curriculum includes standards for theoretical knowledge and practical skills.

The curriculum includes standards for theoretical knowledge and practical skills.


Performance of supervised basic GUS prior to Level 1 certification.


Performance of unsupervised basic GUS. Basic GUS is easy and effective assessment of

basic gynecological conditions with ultrasound. Basic GUS certification should be obtained

by all specialists in gynecology and obstetrics. It is recommended that all gynecologists

obtain Level 1 competence, preferably during their specialist training. At least Level 1

competence should be obtained by anyone performing GUS unsupervised.

Level 2 (advanced)

Subspecialized gynecologist who performs basic and advanced GUS most working days.

Advanced GUS: all gynecological ultrasound procedures beyond basic level. Advanced

gynecological ultrasound certification is typically obtained by subspecialized specialists in

gynecology.

Level 3 (expert)

Subspecialized experts who perform basic and advanced GUS every working day and

most of the day, and who is active with GUS related science and teaching. Only very few

gynecologists obtain expert GUS level 3 certification. They would typically be employed in

a few university hospital centers.

71


(1) Course pretest

(2) Theory course of basic GUS


(4) Practical hands-on course of basic GUS

(2) Course exam in theory and practice of basic GUS

(3) Supervised procedures of basic GUS

(4) Level 1 certification of basic GUS

(5) Unsupervised maintenance of basic GUS

(6) Theory & practice course of advanced GUS

(7) Course exam of advanced GUS

(8) Supervised procedures of advanced GUS

(9) Level 2 certification of advanced GUS - theory & practice

(10) Level 3 certification of expert GUS: Level 2 certified + minimum 400 basic and

advanced GUS procedures per year for at least two years + teaching experience within

advanced GUS + minimum three scientific publications about gynecological ultrasound in

peer reviewed papers

3.2 Level 1


Course





Ergonomics

Sterility

Safety

Administration

Sonoanatomy

Sonopathology

72


To be able to:

• Perform a basic GUS exam







- HOT 1

o Basic GUS views on sonosimulators


- HOT 2

o Basic UVS views on patients or sonosimulators


- HOT 3



GUS:





the trainee should collect a minimum of 100 GUS exams under supervision: 50 fully

supervised basic GUS exams (TYPE A exams) + 50 autonomously collected (TYPE B





73
















exam can be a real clinical GUS exam or a simulated GUS exam: Didactic cases
















74











• UVS exam on a healthy volunteer (assessment of technical skills in machine setting,


• UVS on a real patient with relevant morbidity (overall practical assessment)


3.3 Level 2



programme.








examinations within advanced GUS before Level 2 certification.


should include ideally all Level 2 competencies for advanced GUS. A procedure

75

can be a real clinical GUS procedure or a simulated procedure. A minimum of 25

procedures have to be real clinical GUS procedures. • The theoretical and practical certification should encompass the full range of



examinations each year within their Level 2 subspecialty of advanced gynecological

ultrasound.


Practical Course








o advanced GUS


o complications

o safety


o gynecological ultrasound

3.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking GUS or


in this area.

76

3.5 Maintenance of skills Having been assessed as competent to practice there will be a need for continued



Level 1: the practitioner should perform at least 100 basic GUS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced GUS exams each

year.

Level 3: the practitioner should perform at least 400 basic and advanced GUS exams each

yeaGU


• include GUS in their continued medical education (CME)




4. Endocrinological ultrasound

4.1 Introduction


specialists of endocrinology who perform endocrinological ultrasound (EUS). It includes


Introductory level

Performance of supervised basic EUS prior to Level 1 certification.

Level 1 (basic)

Performance of unsupervised basic EUS. Basic EUS is easy and effective basic

assessment of endocrinological conditions with ultrasound. Basic EUS certification should

be obtained by all specialists in endocrinology. It is recommended that all endocrinologists

obtain Level 1 competence, preferably during their specialist training. At least Level 1

competence should be obtained by anyone performing EUS unsupervised.

Level 2 (advanced)

Subspecialized experts who perform basic and advanced EUS most working days.

Advanced EUS is all EUS procedures beyond basic level. Advanced EUS certification is

typically obtained by specialists in endocrinology subspecialized in thyroid diseases.

Level 3 (expert)

Subspecialized experts who perfors basic and advanced EUS every working day and most

of the day, and who is active with science and teaching. Only very few endocrinologists

obtain expert EUS level 3 certification. They would typically be employed in a few

university hospital centers.



(2) Theory course of basic EUS

78


(4) Practical hands-on course of basic EUS

(2) Course exam in theory and practice of basic EUS

(3) Supervised procedures of basic EUS

(4) Level 1 certification of basic EUS

(5) Unsupervised maintenance of basic EUS

(6) Theory & practice course of advanced EUS

(7) Course exam of advanced EUS

(8) Supervised procedures of advanced EUS

(9) Level 2 certification of advanced EUS - theory & practice

(10) Level 3 certification of expert EUS: Level 2 certified + minimum 500 basic and

advanced EUS procedures per year for at least two years + teaching experience within

advanced EUS + minimum three scientific publications about EUS in peer reviewed

papers (PhD level)

4.2 Level 1


Course





Ergonomics

Sterility

Safety

Administration

Sonoanatomy

• Basic 2D and Color Doppler views in longitudinal and cross sectional scans

o thyroid gland

o parathyroid glands

o lymph nodes

79

Sonopathology

• Thyroid gland

o Measure size

o Estimate color (dark/light +/- thyroiditis/sequelae)

o Estimate homogeneity/inhomogeneity

If inhomogeneity

• Solitary nodus

• Multiple nodi

• Dominating nodus

• Calcifications/microcalcifications

If nodus

• Simple cyst

• Semisolid cyst

• Calcifications in the cystic wall

• Parathyroid glands - Identify parathyroid glands (pathological)

• Lymph nodes

- normal - reactive - pathological


To be able to:

• Perform a basic EUS exam Level 1 Theoretical & Practical Course






- HOT 1

o Basic EUS views on normal models


80

- HOT 2

o Basic EUS views on normal models or patients or sonosimulators


- HOT 3







the trainee should collect a minimum of 50 EUS exams under supervision: 25 fully

supervised basic EUS exams (TYPE A exams) + 25 autonomously collected (TYPE B



















81


exam can be a real clinical EUS exam or a simulated EUS exam: Didactic cases








Final Level 1 certification of basic EUS


















• EUS exam on a healthy volunteer (assessment of technical skills in machine setting,


82

• EUS on a real patient with relevant morbidity (overall practical assessment)


4.3 Level 2



programme.








examinations within advanced EUS before Level 2 certification.


should include ideally all Level 2 competencies for advanced EUS. A procedure can

be a real clinical EUS procedure or a simulated procedure. A minimum of 25

procedures have to be real clinical EUS procedures. • The theoretical and practical certification should encompass the full range of



examinations each year within their Level 2 subspecialty of advanced

endocrinological ultrasound.


Practical Course






83



o advanced EUS

o anatomy and sonoanatomy focusing on the thyroid gland

o complications

o safety


o ultrasound guided thyroid gland biopsies

4.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking ultrasound

including EUS and teaching, research and development within their subspecialized field

and will be an expert in this area. Typically a level 3 EUS expert would be a radiologist

rather than an endocrinologist.





Level 1: the practitioner should perform at least 100 basic EUS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced EUS exams each

year.

Level 3: the practitioner should perform at least 400 basic and advanced EUS exams each

year.


• include EUS in their continued medical education (CME)




84

5. Pediatric ultrasound


specialists of pediatrics who perform pediatric ultrasound (PUS).The curriculum of PUS is

modular in order to relate the training to the specialist requirements of the trainee. Within

any one level of training it may be appropriate for a trainee to become proficient in some

but not all of the individual modules and only undertake ultrasound practice in this/these

areas. Except level one which contains the basic common trunk for all specialists of

pediatrics.

The level 1 modules of pediatric ultrasound are:

• FATE protocol • eFAST protocol

o (including pleura/lung, urinary bladder and internal jugular vein)

• vascular access • brain

The level 2 and level 3 modules of pediatric ultrasound are:

• cardiology • neurology • rheumatology • nephrourology

• gastroenterology • emergency medicine/infectious diseases • neonatology

5c1. Pediatric FATE (focus assessed transthoracic echocardiography)

5c1.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pediatrics who perform

focused cardiac ultrasound – also called FATE (focus assessed transthoracic

echocardiography). FATE includes standards for theoretical knowledge and practical skills.


Performance of supervised basic pediatric FATE prior to Level 1 certification.

Level 1 (basic) pediatric FATE certification

Performance of unsupervised basic pediatric FATE. Basic pediatric FATE is easy and

effective basic assessment of haemodynamics. Basic pediatric FATE certification should

be obtained by all clinical specialists assessing potentially acute or critically ill pediatric

patients. It is especially recommended that all pediatrics obtain Level 1 pediatric FATE

competence, preferably prior to or during their specialist training. At least Level 1

competence should be obtained by anyone performing basic pediatric FATE

unsupervised.

Level 2 (advanced) pediatric FATE certification

Subspecialized clinical specialist of pediatrics who perform focused cardiac assessment

with ultrasound most working days. Advanced pediatric FATE is typically obtained by

specialists in pediatrics subspecialized in neonatology, pediatric emergency

medicine/infectious diseases or pediatric cardiology.

Level 3 (expert) pediatric FATE certification

Clinical specialists who perform basic and advanced pediatric FATE every working day

and most of the day, and who are active with pediatric FATE related science and teaching.

Only very few clinical specialists employing pediatric FATE obtain the expert pediatric

FATE level 3 certification. They are typically employed in a few university hospital centers.

86

Typical progression from introduction level to level 3


(2) Theory course of basic pediatric FATE


(4) Practical hands-on course of basic pediatric FATE

(2) Course exam in theory and practice of basic pediatric FATE

(3) Proctored practice (supervised procedures) of basic pediatric FATE

(4) Level 1 certification of basic pediatric FATE

(5) Unsupervised maintenance of basic pediatric FATE

(6) Theory & practice course of advanced pediatric FATE

(7) Course exam of advanced pediatric FATE

(8) Supervised procedures of advanced pediatric FATE

(9) Level 2 certification of advanced pediatric FATE - theory & practice

(10) Level 3 certification of expert pediatric FATE: Level 2 certified + minimum 400 basic

and advanced pediatric FATE exams per year for at least two years + teaching experience

within advanced pediatric FATE + minimum three pediatric FATE related scientific

publications in peer reviewed papers (PhD level)

5c1.2 Level 1


Course







Ergonomics

Sterility

Safety

87

Administration

• Implementation of a focused echocardiography program

Sonoanatomy



o apical 4-chamber



aortic valve (base)

mitral leaflet tips

papillary muscles

Cardiac function



ejection fraction












Sonopathology

• Basic cardiac chamber dysfunction o dilated left atrium o dilated left ventricle

o dilated right atrium o dilated right ventricle

88

o hypertrophy left ventricle


basic US diagnosis of cardiac tamponade US guided pericardiocentesis

• Pedunculated masses


• Hypovolemia


To be able to perform a basic pediatric FATE exam:


standard views

• To recognise and differentiate between normal anatomy/physiology and pathology • To diagnose common abnormalities within the cardiovascular system • To recognize when a referral for a second opinion is indicated • To understand the relationship between echocardiographic imaging and other

diagnostic imaging techniques • Perform focused point-of-care echocardiographic hemodynamic monitoring of

patient response to interventions and diagnostics: o Ventricular function

Systolic function and wall motion abnormalities

Diastolic function o Hypovolemia and volume responsiveness o Tamponade and pericardial disease o The sepsis syndromes

o Effects of preload and afterload and assessment of filling status o Acute cor pulmonale o Hypoxemia o Chest trauma

o Assessment of shock o Peri-resuscitation

89

o Failure to wean from mechanical ventilation

o Patent Ductus arteriosus o Hemodynamic measurements







- HOT 1



- HOT 2



- HOT 3



pediatric FATE:




• Within 6 months after the course, the trainee should collect a minimum of 25 fully

supervised basic pediatric FATE exams (TYPE A exams) + 25 autonomously collected

(TYPE B exams, for later validation). All exams must be archived in digital format and

data collected in the logbook (excel file). When digital storage (strongly encouraged) is

not available, detailed printouts of exams must be collected in a way to allow for

understanding of dynamic phenomena (end-diastole/end-systole; end-expiration/end-

inspiration; M-mode)

90

• When local tutors are not available, for the 25 fully supervised exams a period in a

CECLUS certified International Training Center is required. Alternatively the 25 TYPE A






certification.




a distant tutor (see above). Training in Cardiological Echo Labs is encouraged,

especially to acquire confidence with main TTE views. Focused Echo should be

preferrably performed in patients with pathological hemodynamics.

• Case mix should include: LV dysfunction, RV dysfunction (acute cor pulmonale),

hypovolemia, vasoplegia, cardiac tamponade, cardiac standstill, valvular disease.

• The following scenarios may be represented: PEA, cardiac arrest, septic shock,

trauma, congenital cardiac disease.








certification

Final Level 1 certification of basic pediatric FATE




91

















• TTE on a real critical or cardially morbid patient (overall practical assessment,

including ECHO-guided patient management)




technically competent in the execution of a Focused Echo exam. Their clinical competence

in image integration into the critical or acute cardiac patient management should though

be certified by provision of minimum 25 documented exams (Logbook) + exam on a critical

patient + case discussion.

92

5c1.3 Level 2 The training requisite to this level of practice would be gained during a period of sub-


programme.








examinations within advanced pediatric FATE before Level 2 certification.


which should include ideally all Level 2 competencies for advanced FATE.


sonopathology listed below.


advanced pediatric FATE examinations each year.


Practical Course

o new ultrasound modalities (eg. 4D ultrasound, MRI, image fusion)

o contrast agents







o advanced pediatric FATE:

o systolic function

93






Doppler (PWD))






o pleural effusion

o pathology (septic shock, chest trauma, tamponade, pulmonary oedema

(cardiogenic and non-cardiogenic), weaning failure from mechanical

ventilation, ARDS, acute valvular dysfunction)






o application of extended FATE views

subcostal vena cava










94


o advanced pediatric FATE

o perform the advanced pediatric FATE protocol


o estimated contractility (systolic function) of both ventricles


the left ventricle













Pulsed Doppler



5c1.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking pediatric FATE

or teaching, research and development within their subspecialized field and will be an




specialised examinations including the use of ultrasound guided interventional procedures.

95

5c1.5 Maintenance of skills




Level 1: the practitioner should perform at least 100 basic pediatric FATE exams each

year.

Level 2: the practitioner should perform at least 200 basic and advanced pediatric FATE

exams each year.

Level 3: the practitioner should perform at least 400 basic and advanced pediatric FATE

exams each year.


• include pediatric FATE in their continued medical education (CME)





• Practicioners should perform at least 50 basic pediatric FATE examinations annually. • Recertification every 2 years, by submission of logbook.

• Refresher course (4 hours).

5c2. Pediatric extended FAST (focused assessment with sonography in trauma)

5c2.1 Introduction This protocol is intended for CECLUS certification Level 1 of pediatrics who perform

pediatric focused assessment with sonography in trauma – also called FAST. Pediatric

FAST includes standards for theoretical knowledge and practical skills.

The extended version of FAST is presented which includes assessment of:

- pericardial effusion

- peritoneal effusion

- pleural effusion

- abdominal aorta

- inferior vena cava

- urinary bladder

Typical progression to extended pediatric FAST certification


(2) Theory course of extended pediatric FAST


(4) Practical hands-on course of extended pediatric FAST

(2) Course exam in theory and practice of extended pediatric FAST

(3) Proctored practice (supervised procedures) of extended pediatric FAST

(4) Certification of extended pediatric FAST

5c2.2 Level 1 Knowledge Base and Recommended Contents of Theoretical & Practical Course

A minimum of 10 hours theoretical and practical teaching is required preferably at the

beginning of the training period. Prior to the theory course the practitioner performs a

pretest. The theory course should be concluded with a posttest with a minimum level of

97

performance before entering the practical hands-on course. The theoretical and practical

courses should cover:







Ergonomics

Sterility

Safety

Administration

• Implementation of an extended program

Sonoanatomy

• Extended FAST 2D and M-mode views

o Pleura

Anterior, bilateral


o Pericardium

o Peritoneum

Liver/right kidney

Spleen/left kidney


Urinary bladder

Abdominal aorta

Inferior vena cava

Sonopathology

• Pneumothorax

• Pleura effusion • Cardiac tamponade • Peritoneal effusion

98

• Distended urinary bladder

• Abdominal aortic enlargement • Hypovolemia

Extended Pediatric FAST Competencies to be acquired

To be able to perform an extended pediatric FAST exam:

• Perform the extended pediatric FAST examinations safely and accurately and

acquire all standard views • To recognise and differentiate between normal anatomy/physiology and pathology


imaging techniques

Practical course: Organisation of practical sessions


- HOT 1

o Extended FAST views on normal models


- HOT 2

o Extended FAST views on normal models or patients or sonosimulators


- HOT 3


Theoretical and practical course exam on extended pediatric FAST



Proctored extended pediatric FAST practice


supervised extended pediatric FAST exams (TYPE A exams) + 25 autonomously

99

collected (TYPE B exams, for later validation). All exams must be archived in digital

format and data collected in the logbook (excel file). When digital storage (strongly

encouraged) is not available, detailed printouts of exams must be collected in a way to

allow for understanding of dynamic phenomena.








certification.




a distant tutor (see above). The FAST exams should be preferrably performed in

patients with pathological hemodynamics.

• Case mix should include: Pneumothorax, pleura effusion, cardiac tamponade,

peritoneal effusion, distended urinary bladder, abdominal aortic enlargement, and

hypovolemia.


trauma, congenital cardiac disease.








certification

100

Final certification of extended pediatric FAST













• Extended FAST on a healthy volunteer (assessment of technical skills in machine


• Extended FAST on a real patient (overall practical assessment, including FAST-guided

patient management)



• Practicioners should perform at least 50 extended pediatric FAST examinations

annually. • Recertification every 2 years, by submission of logbook. • Refresher course (4 hours).


Physicians holding national or international estende FAST accreditation are considered

technically competent in the execution of an estended pediatric FAST exam. Their clinical

competence in image integration into the critical or acute cardiac patient management

101

should though be certified by provision of minimum 10 documented exams (Logbook) +

exam on a critical patient + case discussion.

5c3. Pediatric ultrasound guided vascular access

5c3.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pediatrics who perform

pediatric ultrasound guided vascular access (UGVA). Pediatric UGVA includes standards

for theoretical knowledge and practical skills.


Performance of supervised basic pediatric UGVA prior to Level 1 certification.

Level 1 (basic) pediatric UGVA certification

Performance of unsupervised basic pediatric UGVA. Basic pediatric UGVA certification

should be obtained by all clinical specialists managing pediatric patients. It is especially

recommended that all pediatrics obtain Level 1 pediatric UGVA competence, preferably

prior to or during their specialist training. At least Level 1 competence should be obtained

by anyone performing basic pediatric UGVA unsupervised.

Level 2 (advanced) pediatric UGVA certification

Subspecialized clinical specialist of pediatrics who perform pediatric UGVA most working

days. Advanced pediatric UGVA is typically obtained by specialists in pediatrics

subspecialized in neonatology.

Level 3 (expert) pediatric UGVA certification

Clinical specialists who perform basic and advanced UGVA every working day, and who

are active with UGVA related science and teaching. Only very few clinical specialists

employing pediatric UGVA obtain the expert pediatric UGVA level 3 certification – if any.

They would typically be employed in a few university hospital centers.



(2) Theory course of basic pediatric UGVA


103

(4) Practical hands-on course of basic pediatric UGVA

(2) Course exam in theory and practice of basic pediatric UGVA

(3) Proctored practice (supervised procedures) of basic pediatric UGVA

(4) Level 1 certification of basic pediatric UGVA

(5) Unsupervised maintenance of basic pediatric UGVA

(6) Theory & practice course of advanced pediatric UGVA

(7) Course exam of advanced pediatric UGVA

(8) Supervised procedures of advanced pediatric UGVA

(9) Level 2 certification of advanced pediatric UGVA - theory & practice

(10) Level 3 certification of expert pediatric UGVA: Level 2 certified + minimum 400 basic

and advanced pediatric UGVA exams per year for at least two years + teaching

experience within advanced pediatric UGVA + minimum three pediatric UGVA related

scientific publications in peer reviewed papers (PhD level)

5c3.2 Level 1


Course






- Doppler (color)

- In-plane/out-of-plane

Ergonomics

Sterility

Safety

Administration

• Implementation of an UGVA program

Sonoanatomy

• Superficial cubital and antebrachial veins

104

• Brachial veins

• Major saphenous vein

• Femoral vein

• Internal jugular vein

• Subclavian vein/axillary vein

• Radial artery

• Femoral artery

Sonopathology

• Thrombosis

• Complications



To be able to perform basic pediatric UGVA:

• Perform UGVA safely and accurately • To recognise and differentiate between normal anatomy/physiology and pathology • To recognize when a referral for a second opinion is indicated







- HOT 1

o Basic UGVA views on normal models


- HOT 2

o Basic UGVA views on normal models or patients or sonosimulators


- HOT 3

105


Level 1 theoretical and practical course exam on basic UGVA




• Within 3 months after the course, the trainee should collect a minimum 5f 20 fully

supervised basic pediatric UGVA procedures (TYPE A exams) + 25 autonomously




allow for understanding of dynamic phenomena

• When local tutors are not available, for the 25 fully supervised procedures they can be

replaced by 25 autonomously collected exams and internet sharing with a distant tutor

where the exams are uploaded and audited sequentially one-by-one (a dedicated area

will be activated on the CECLUS channel, with reserved access to the trainees page

matched with distance tutor). Lack of information on single cases, not allowing accurate

judgement on trainees competence makes the case not valid for final certification.




a distant tutor (see above).

• Case mix should include UGVA into all abovementioned veins and arteries.


for lack of an adequate number of cases on some types of less frequent UGVA

procedures. These should not be reported in the logbook but rather listed, indicated

separately as part of exam final documentation.

Final Level 1 certification of basic pediatric FATE



106











• UGVA imaging on a healthy volunteer (assessment of technical skills in machine




• Practicioners should perform at least 50 basic pediatric FATE examinations annually. • Recertification every 2 years, by submission of logbook. • Refresher course (1 hour).


Physicians holding national or international UGVA accreditation are considered technically

competent in the execution of basic UGVA. Their clinical competence in UGVA should

though be certified by provision of minimum 25 documented exams (Logbook) + exam on

a model + case discussion.

107

5c3.3 Level 2



programme.








examinations within advanced pediatric UGVA before Level 2 certification.


which should include ideally all Level 2 competencies for advanced UGVA.


advanced pediatric UGVA each year. Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical and

Practical Course




course. The theoretical and practical courses should cover:







o advanced pediatric UGVA:

o Central venous catheters

108

Umbilical vein catheter

Femoral vein catheter

Subclavian vein catheter

o Umbilical artery catheter

o Radial artery catheter


o perform the advanced pediatric UGVA procedures

o apply color Doppler

5c3.4 Level 3 A level 3 practioner is likely to spend a substantial amount of their time undertaking

pediatric UGVA or teaching, research and development within their subspecialized field

and will be an expert in this area.

5c3.5 Maintenance of skills Having been assessed as competent to practice there will be a need for continued





year.


year.


• include pediatric UGVA in their continued medical education (CME)




5d. Pediatric neurology ultrasound 5d.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pediatrics who perform

pediatric neurology ultrasound. Pediatric neurology ultrasound (NUS) includes standards

for theoretical knowledge and practical skills.


Performance of supervised basic pediatric NUS prior to Level 1 certification.

Level 1 (basic) pediatric neurology ultrasound certification

Performance of unsupervised basic pediatric NUS. Basic pediatric NUS certification should

be obtained by all clinical specialists managing pediatric patients. It is especially

recommended that all pediatrics obtain Level 1 pediatric neurology ultrasound

competence, preferably prior to or during their specialist training. At least Level 1

competence should be obtained by anyone performing basic pediatric NUS unsupervised.

Level 2 (advanced) pediatric NUS certification

No Level 2.

Level 3 (expert) pediatric neurology ultrasound certification

No Level 3.

5d.2 Level 1 Level 1 Knowledge Base and Recommended Contents of Level 1 Theoretical & Practical

Course





110


Ergonomics

Sterility

Safety

Administration

• Implementation of an neurology ultrasound program

Sonoanatomy

• Normal brain

Sonopathology

• Cerebral bleeding

o Parenchymal

o Ventricular

• Cerebral midline shift



• To be able to perform basic pediatric neurology ultrasound exam • To recognise and differentiate between normal anatomy/physiology and pathology • To recognize when a referral for a second opinion is indicated







- HOT 1

o Basic neurology ultrasound views on normal models


- HOT 2

111

o Basic neurology ultrasound views on normal models or patients or

sonosimulators


- HOT 3



pediatric neurology ultrasound





supervised basic pediatric NUS procedures (TYPE A exams) + 25 autonomously




allow for understanding of dynamic phenomena

• When local tutors are not available, for the 25 fully supervised procedures they can be

replaced by 25 autonomously collected exams and internet sharing with a distant tutor

where the exams are uploaded and audited sequentially one-by-one (a dedicated area

will be activated on the CECLUS channel, with reserved access to the trainees page

matched with distance tutor). Lack of information on single cases, not allowing accurate





a distant tutor (see above).

• Case mix should include neurology ultrasound exam of all the abovementioned types.


for lack of an adequate number of cases on some types of less frequent NUS exams.

112


part of exam final documentation.

• Final Level 1 certification of basic NUS

• Different trainees will acquire the necessary skills at different rates and the end point of

the training programme should be judged by an assessment of competencies in the

form of theoretical and practical certification. The theoretical and practical certification

should encompass the full range of the Level 1 knowledge database and competencies

to be acquired listed above.













• Neurology ultrasound imaging on a healthy volunteer (assessment of technical skills in

machine setting, image acquisition and storage)


Certification for physicians already holding national/international neurology ultrasound

certifications

Physicians holding national or international neurology ultrasound accreditation are

considered technically competent in the execution of basic pediatric neurology ultrasound .

113

Their clinical competence in neurology ultrasound should though be certified by provision

of minimum 5 documented exams (Logbook) + exam on a model + case discussion.

5d.3 Maintenance • Practicioners should perform at least 50 basic pediatric neurology ultrasound

examinations annually. • Recertification every 2 years, by submission of logbook.

• Refresher course (1 hour).

6. Oto-rhino-laryngeal ultrasound

6.1 Introduction

This curriculum is intended for CECLUS certification Level 1-3 of oto-rhino-laryngologists

who perform oto-rhino-laryngeal ultrasound – also called ORLUS. ORLUS includes


The curriculum of oto-rhino-laryngeal ultrasound (ORLUS) is 3-leveled and modular in

order to relate the training to the specialist requirements of the trainee. Within any one

level of training it may be appropriate for a trainee to become proficient in some but not all

of the individual modules and only undertake ultrasound practice in this/these areas.

Except level one which contains the basic common trunk for all specialists of oto-rhino-

laryngology.


Performance of supervised ORLUS prior to Level 1 certification.

Level 1 (basic) ORLUS certification

Performance of unsupervised basic ORLUS. Basic ORLUS is easy and effective basic

assessment of oto-rhino-laryngeal anatomy and pathology relevant for all oto-rhino-

laryngologists. Basic ORLUS certification should be obtained by all specialists of oto-rhino-

laryngology, preferably prior to or during their specialist training. At least Level 1

competence should be obtained by anyone performing basic ORLUS unsupervised.

Level 2 (advanced) ORLUS certification

Subspecialized clinical specialist of oto-rhino-laryngology. Advanced ORLUS is typically

obtained by specialists subspecialized in neck surgery.

Level 3 (expert) ORLUS certification

Clinical specialists who perform basic and advanced ORLUS every working day and most

of the day, and who are active with ORLUS related science and teaching. Only very few

115

clinical specialists employing ORLUS obtain the expert ORLUS level 3 certification. They

are typically employed in a few university hospital centers.



(2) Theory course of basic ORLUS


(4) Practical hands-on course of basic ORLUS

(2) Course exam in theory and practice of basic ORLUS

(3) Proctored practice (supervised procedures) of basic ORLUS

(4) Level 1 certification of basic ORLUS

(5) Unsupervised maintenance of basic ORLUS

(6) Theory & practice course of advanced ORLUS

(7) Course exam of advanced ORLUS

(8) Supervised procedures of advanced ORLUS

(9) Level 2 certification of advanced ORLUS - theory & practice

(10) Level 3 certification of expert ORLUS: Level 2 certified + minimum 500 basic and

advanced ORLUS exams per year for at least two years + teaching experience within

advanced ORLUS + minimum three ORLUS related scientific publications in peer

reviewed papers (PhD level)

6.2 Level 1


Course







- Sonoelastography (knowledge about)

Ergonomics

116

Sterility

Safety

Administration

• Implementation of a basic ORLUS programme

Sonoanatomy

• basic sonographic 2D views of normal neck anatomy

Sonopathology

• thyroid gland

o measure size

o evaluate colour (dark/light +/- thyroiditis/sequelae)

o evaluate whether the gland is homogenous/in-homogenous

if inhomogenous

• solitary node

• multiple noduli

• dominating node

• calcifications/microcalcifications

if node

• simple cyst

• semisolid cyst

• calcifications in the cystic wall

• Parathyroid gland o identify the parathyroid gland (pathological) o knowledge about parathyroid sonopathology

• Lymph nodes

o describe size and shape normal, reactive, pathological

o hilum o blood flow o levels

• Salivary glands (parotid, submandibular, sublingual)

o describe size o describe echo pattern o cysts o stones o adenomas o dilated gland ducts

117

o tumours

• Carotid artery and internal jugular vein o aneyrisms o thrombosis o knowledge about sonographic features of atherosclerosis

• Median and lateral neck cysts

o identification o measure size

• Neck abscesses


To be able to perform a basic ORLUS exam:

• Perform examinations and procedures safely and accurately and acquire all

standard views • To recognise and differentiate between normal anatomy/physiology and pathology

• To diagnose common abnormalities within the neck • To recognize when a referral for a second opinion is indicated • To understand the relationship between sonographic imaging and other diagnostic

imaging techniques

Perform focused point-of-care ORLUS guided interventions with monitoring of patient

response to interventions and diagnostics

• fine needle aspiration from lymph nodes • fine needle aspiration from the thyroid gland

• fine needle aspiration of neck cysts in adults Level 1 Theoretical & Practical Course






- HOT 1

o Basic ORLUS views on normal models

118


- HOT 2

o Basic ORLUS views on normal models or patients or sonosimulators


- HOT 3







supervised basic ORLUS exams (TYPE A exams) + 25 autonomously collected (TYPE

B exams, for later validation). All exams must be archived in digital format and data

collected in the logbook (excel file). When digital storage (strongly encouraged) is not

available, detailed printouts of exams must be collected in a way to allow for










certification.




a distant tutor (see above). Focused ORLUS should be preferrably performed in

patients with relevant pathology.

119

• Case mix should include all the pathological conditions mentioned above.








certification

Final Level 1 certification of basic ORLUS


















• ORLUS on a healthy volunteer (assessment of technical skills in machine setting,


120

• ORLUS on a patient with relevant pathological condition (overall practical assessment)


Certification for physicians already holding national/international ORLUS certifications

Physicians holding national or international ORLUS accreditation are considered

technically competent in the execution of a Focused ORLUS exam. Their clinical

competence in image integration into the oto-rhino-laryngeal patient management should

though be certified by provision of minimum 30 documented exams (Logbook) + exam on

a patient + case discussion

6.3 Level 2



programme.








examinations within advanced ORLUS before Level 2 certification.


which should include ideally all Level 2 competencies for advanced ORLUS for the

particular modality.

• The theoretical and practical certification should encompass the full module-specific

range of sonopathology listed below.


module-specific advanced ORLUS examinations each year.

121


Practical Course





• new ultrasound modalities (eg. 3D and 4D ultrasound)

• contrast agents

• advanced sound and ultrasound physics

• advanced ultrasound system machine controls

• advanced ultrasound system user controls

• advanced ultrasound techniques

• advanced administration (teaching, documentation, organization)

• advanced ultrasound artefacts

• advanced module-specific ORLUS pathology


Perform the advanced module-specific ORLUS examinations and procedures.

o Sonoelastography

6.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking advanced

ORLUS or teaching, research and development within their subspecialized field and will be

an expert in this area.





122

Level 1: the practitioner should perform at least 50 basic ORLUS exams each year.

Level 2: the practitioner should perform at least 100 basic and advanced ORLUS exams

each year.

Level 3: the practitioner should perform at least 200 basic and advanced ORLUS exams

each year.


• include ORLUS in their continued medical education (CME)




7. Orthopedic surgery ultrasound

7.1 Introduction

This curriculum is intended for CECLUS certification Level 1-3 of orthopedic surgeons who

perform orthopedic surgery ultrasound – also called OSUS. OSUS includes standards for


The curriculum of orthopedic surgery ultrasound (OSUS) is 3-leveled and modular in order

to relate the training to the specialist requirements of the trainee. Within any one level of

training it may be appropriate for a trainee to become proficient in some but not all of the

individual modules and only undertake ultrasound practice in this/these areas. Except level

one which contains the basic common trunk for all specialists of orthopedic ultrasound.

The level 1 modules of OSUS are:

• general OSUS • basic OSUS

o shoulder and elbow

o wrist and hand

o hip

o knee

o ankle and foot

The level 2 and level 3 modules of OSUS are:

• advanced shoulder and elbow OSUS • advanced wrist and hand OSUS

• advanced hip OSUS

• advanced knee OSUS

• advanced ankle and foot OSUS


Performance of supervised OSUS prior to Level 1 certification.

Level 1 (basic) OSUS certification

Performance of unsupervised basic OSUS. Basic OSUS is easy and effective basic

assessment of musculoskeletal anatomy and pathology relevant for all orthopedic

surgeons. Basic OSUS certification should be obtained by all specialists of orthopedic

surgery, preferably prior to or during their specialist training. At least Level 1 competence

should be obtained by anyone performing basic OSUS unsupervised.

Level 2 (advanced) OSUS certification

Subspecialized clinical specialist of orthopedic surgery . Advanced OSUS is typically

obtained by specialists subspecialized in either shoulder/elbow, wrist/hand, hip, knee, or

ankle/foot orthopedic surgery.

Level 3 (expert) OSUS certification

Clinical specialists who perform basic and advanced OSUS every working day and most of

the day, and who are active with OSUS related science and teaching. Only very few

clinical specialists employing OSUS obtain the expert OSUS level 3 certification. They are

typically employed in a few university hospital centers.



(2) Theory course of basic OSUS


(4) Practical hands-on course of basic OSUS

(2) Course exam in theory and practice of basic OSUS

(3) Proctored practice (supervised procedures) of basic OSUS

(4) Level 1 certification of basic OSUS

(5) Unsupervised maintenance of basic OSUS

(6) Theory & practice course of advanced OSUS

125

(7) Course exam of advanced OSUS

(8) Supervised procedures of advanced OSUS

(9) Level 2 certification of advanced OSUS - theory & practice

(10) Level 3 certification of expert OSUS: Level 2 certified + minimum 500 basic and

advanced OSUS exams per year for at least two years + teaching experience within

advanced OSUS + minimum three OSUS related scientific publications in peer reviewed

papers (PhD level)

7.2 Level 1


Course







Ergonomics

Sterility

Safety

Administration

• Implementation of a basic OSUS programme

Sonoanatomy

• basic sonographic 2D views of normal muscles and joints

Sonopathology

• shoulder

o complete rotator cuff lesion

o rotator cuff calcification (different types)

o shoulder joint effusion and synovitis

o subacromial-subdeltoid bursitis

o biceps tendon (tendinopathy, luxation, rupture)

126

o Hill-Sachs lesion

o acromioclavicular joint pathology

o rheumatoid erosions

• elbow

o lateral and medial epicondylitis

o elbow joint effusion and synovitis

o rheumatoid lesions

• wrist and hand

o ganglionic cyst

o tenosynovitis

o tendon rupture

o joint effusion and synovitis

o median nerve


• hip

o hip joint effusion and synovitis

o trochanteric bursitis


• knee

o knee joint effusion and synovitis

o Baker’s cyst (and rupture)

o patella ligament tendinopathy

o Quadriceps femoris tendon rupture

o identification of meniscs

o large meniscal cysts

o Osgood-Schlatter

o Collateral ligament lesion

o all cysts, bursiti, ganglions


• ankle and foot


o Achilles tendinopathy and rupture

127

o tenosynovitis

o exostoses

o fasciitis plantaris


• muscles, general

o large muscle ruptures

o abscesses

o myositis ossificans

• varia

o identification of bone pathology

o fluid in relation to prostheses/osteosyntheses

o detection of foreign bodies


To be able to perform a basic OSUS exam:


standard views

• To recognise and differentiate between normal anatomy/physiology and pathology • To diagnose common abnormalities within the musculoskeletal system • To recognize when a referral for a second opinion is indicated • To understand the relationship between sonographic imaging and other diagnostic

imaging techniques

• Perform focused point-of-care OSUS guided interventions with monitoring of patient

response to interventions and diagnostics Level 1 Theoretical & Practical Course






128

- HOT 1

o Basic OSUS views on normal models


- HOT 2

o Basic OSUS views on normal models or patients or sonosimulators


- HOT 3







supervised basic OSUS exams (TYPE A exams) + 50 autonomously collected (TYPE


collected in the logbook (excel file). When digital storage (strongly encouraged) is not

available, detailed printouts of exams must be collected in a way to allow for










certification.




129

a distant tutor (see above). Focused OSUS should be preferrably performed in

patients with relevant pathology.









certification

• Final Level 1 certification of basic OSUS


















130

• OSUS on a healthy volunteer (assessment of technical skills in machine setting, image


• OSUS on a patient with pathological condition relevant for orthopedic surgery (overall

practical assessment)



• Practicioners should perform at least 50 basic OSUS examinations annually. • Recertification every 2 years, by submission of logbook.

• Refresher course (4 hours).

Certification for physicians already holding national/international OSUS certifications

Physicians holding national or international OSUS accreditation are considered technically

competent in the execution of a Focused OSUS exam. Their clinical competence in image

integration into the orthopedic surgery patient management should though be certified by

provision of minimum 30 documented exams (Logbook) + exam on a patient + case

discussion.

7.3 Level 2



programme.








examinations within advanced OSUS before Level 2 certification.

131


which should include ideally all Level 2 competencies for advanced OSUS for the





module-specific advanced OSUS examinations each year. Level 2 Knowledge Base and Recommended Contents of Level 2 Theoretical and

Practical Course






• contrast agents







• advanced module-specific OSUS pathology

• shoulder

o partial rotator cuff lesion

o dynamic examination for impingement

o ganglions

o rotator cuff interval pathology

o frozen shoulder

o nerve entrapment

o identification of posterior and anterior glenoid labrum

o ultrasound guided interventions

132

• elbow

o biceps and triceps tendinopathy and rupture

o nerve entrapment


• wrist and hand

o Carpal tunnel syndrome

o tendon adherences

o ligament and pulley lesions

o other tumors than ganglions


• hip

o other bursitis than trochanteric

o osteoarthritis

o identification of anterior labrum

o identification of iliopsoas tendon

o snapping hip

o inguinal hernia

o groin pain

o pathology of the infant hip


• knee

o meniscus tear

o meniscus cyst

o Runner’s knee

o pathology of small muscle tendons

o osteoarthritis

o cartilage lesions


• ankle and foot

o Morton’s neuroma

o tarsal tunnel syndrome

133

o ligament strain



o small muscle rupture

o late complications of muscle rupture

o identification of common muscle tumors

• varia

o withdrawal of foreign bodies

o bone pathology (fractures, tumors)

o Doppler examination of tendons and joints

o entesopathy

o identification of common nerves



Perform the advanced module-specific OSUS examinations and procedures.

7.4 Level 3


OSUS or teaching, research and development within their subspecialized field and will be

an expert in this area.





Level 1: the practitioner should perform at least 100 basic OSUS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced OSUS exams

each year.

134

Level 3: the practitioner should perform at least 400 basic and advanced OSUS exams

each year.


• include OSUS in their continued medical education (CME)




8. Rheumatological ultrasound

8.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of rheumatologists who

perform rheumatological ultrasound – also called RUS. RUS includes standards for


The curriculum of rheumatological ultrasound (RUS) is 3-leveled and modular in order to

relate the training to the specialist requirements of the trainee. Within any one level of

training it may be appropriate for a trainee to become proficient in some but not all of the

individual modules and only undertake ultrasound practice in this/these areas. Except level

one which contains the basic common trunk for all specialists of rheumatology.

The level 1 modules of RUS are:

• general RUS • basic RUS

o shoulder joint o elbow joint

o wrist joint

o finger joints

o hip joint

o knee joint

o ankle joint

o toe joints

The level 2 and level 3 modules of RUS are:

• advanced shoulder and elbow RUS • advanced wrist and hand RUS

• advanced hip RUS

• advanced knee RUS

• advanced ankle and foot RUS


Performance of supervised RUS prior to Level 1 certification.

Level 1 (basic) RUS certification

Performance of unsupervised basic RUS. Basic RUS is easy and effective basic

assessment of musculoskeletal anatomy and pathology relevant for all rheumatologists.

Basic RUS certification should be obtained by all specialists of rheumatology, preferably

prior to or during their specialist training. At least Level 1 competence should be obtained

by anyone performing basic RUS unsupervised.

Level 2 (advanced) RUS certification

Subspecialized clinical specialist of rheumatology. Advanced RUS is typically obtained by

specialists subspecialized in sports medicine.

Level 3 (expert) RUS certification

Clinical specialists who perform basic and advanced RUS every working day and most of

the day, and who are active with RUS related science and teaching. Only very few clinical

specialists employing RUS obtain the expert RUS level 3 certification. They are typically

employed in a few subspecialized hospital centers.



(2) Theory course of basic RUS


(4) Practical hands-on course of basic RUS

(5) Course exam in theory and practice of basic RUS

(6) Proctored practice (supervised procedures) of basic RUS

(7) Level 1 certification of basic RUS

(8) Unsupervised maintenance of basic RUS

(9) Theory & practice course of advanced RUS

(10) Course exam of advanced RUS

(11) Supervised procedures of advanced RUS

137

(9) Level 2 certification of advanced RUS - theory & practice

(10) Level 3 certification of expert RUS: Level 2 certified + minimum 500 basic and

advanced RUS exams per year for at least two years + teaching experience within

advanced RUS + minimum three RUS related scientific publications in peer reviewed

papers (PhD level)

8.2 Level 1


Course







Ergonomics

Sterility

Safety

Administration

• Implementation of a basic RUS programme

Sonoanatomy

• basic sonographic 2D views of normal muscles and joints

Sonopathology

• shoulder

o rotator cuff lesion

o rotator cuff calcification (different types)

o shoulder joint effusion and synovitis

o subacromial-subdeltoid bursitis

o biceps tendon (tendinopathy, luxation, rupture)

o Hill-Sachs lesion

o acromioclavicular joint pathology

138

o joint destruction

• elbow

o lateral and medial epicondylitis

o elbow joint effusion and synovitis

o joint destruction

• wrist and hand

o ganglionic cyst

o tenosynovitis

o tendon rupture


o median nerve in carpal tunnel syndrome

o joint destruction

• hip

o hip joint effusion and synovitis

o trochanteric bursitis

o joint destruction

• knee

o knee joint effusion and synovitis

o Baker’s cyst (and rupture)

o patella ligament tendinopathy

o Osgood-Schlatter

o Collateral ligament lesion

o all cysts, bursiti, ganglions

o joint destruction

• ankle and foot


o Achilles tendinopathy and rupture

o tenosynovitis

o exostoses

o fasciitis plantaris

o joint destruction


139

o large muscle ruptures

o abscesses

o myositis ossificans

• varia

o identification of bone pathology

o fluid in relation to prostheses/osteosyntheses

o detection of foreign bodies


To be able to perform a basic RUS exam:


standard views • To recognise and differentiate between normal anatomy/physiology and pathology

• To diagnose common abnormalities within the musculoskeletal system • To recognize when a referral for a second opinion is indicated • To understand the relationship between sonographic imaging and other diagnostic

imaging techniques

• Perform focused point-of-care RUS guided interventions with monitoring of patient

response to interventions and diagnostics Level 1 Theoretical & Practical Course






- HOT 1

o Basic RUS views on normal models


- HOT 2

o Basic RUS views on normal models or patients or sonosimulators


140

- HOT 3







supervised basic RUS exams (TYPE A exams) and 25 fully supervised intraarticular

injections + 50 autonomously collected (TYPE B exams, for later validation) and 25

autonomously collected intraarticular injections. All exams must be archived in digital


encouraged) is not available, detailed printouts of exams must be collected.

• When local tutors are not available, for the fully supervised exams and procedures a

period in a CECLUS certified International Training Center is required. Alternatively the

TYPE A exams can be replaced by autonomously collected exams and internet sharing

with a distant tutor where the exams are uploaded and audited sequentially one-by-one

(a dedicated area will be activated on the CECLUS channel, with reserved access to

the trainees page matched with distance tutor). Lack of information on single cases,

not allowing accurate judgement on trainees competence makes the case not valid for

final certification.

• The last autonomously performed exams can be validated either by: a) physical



a distant tutor (see above). Focused RUS should be preferrably performed in patients

with relevant pathology.






141




certification

Final Level 1 certification of basic RUS


















• RUS on a healthy volunteer (assessment of technical skills in machine setting, image


• RUS on a patient with pathological condition relevant for rheumatology (overall

practical assessment)


142


• Practicioners should perform at least 50 basic RUS examinations and 25 intraarticular

injections annually. • Recertification every 2 years, by submission of logbook. • Refresher course (4 hours).

Certification for physicians already holding national/international RUS certifications

Physicians holding national or international RUS accreditation are considered technically

competent in the execution of a Focused RUS exam. Their clinical competence in image

integration into the rheumatology patient management should though be certified by

provision of minimum 30 documented exams (Logbook) + exam on a patient + case

discussion.

8.3 Level 2



programme.








examinations within advanced RUS before Level 2 certification.


which should include ideally all Level 2 competencies for advanced RUS for the





module-specific advanced RUS examinations each year.

143


Practical Course






• contrast agents







• advanced module-specific RUS pathology

• shoulder

o partial rotator cuff lesion

o dynamic examination for impingement

o ganglions

o rotator cuff interval pathology

o frozen shoulder

o nerve entrapment

o identification of posterior and anterior glenoid labrum


• elbow

o biceps and triceps tendinopathy and rupture

o nerve entrapment


• wrist and hand

o tendon adherences

o ligament and pulley lesions

144

o other tumors than ganglions


• hip

o other bursitis than trochanteric

o osteoarthritis

o identification of anterior labrum

o identification of iliopsoas tendon

o snapping hip

o inguinal hernia

o groin pain

o pathology of the infant hip


• knee

o meniscus tear

o meniscus cyst

o Runner’s knee

o pathology of small muscle tendons

o osteoarthritis

o cartilage lesions


• ankle and foot

o Morton’s neuroma

o tarsal tunnel syndrome

o ligament strain

o ultrasound guided intervention


o small muscle rupture

o late complications of muscle rupture

o identification of common muscle tumors

• varia

o withdrawal of foreign bodies

o bone pathology (fractures, tumors)

145

o Doppler examination of tendons and joints

o entesopathy

o identification of common nerves



Perform the advanced module-specific RUS examinations and procedures.

8.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking advanced RUS

or teaching, research and development within their subspecialized field and will be an

expert in this area.





given in the text.


• include RUS in their continued medical education (CME)



• keep up to date with relevant literatur

9. Infectious Diseases Ultrasound

9.1 Introduction The curriculum of infectious diseases ultrasound (IDUS) is modular in order to relate the

training to the specialist requirements of the trainee. Level one which contains the basic

common trunk for all specialists of infectious medicine. At the present time it is not

appropriate to define Level 2 and 3 curricula for IDUS.

The modules of IDUS are:

- Vascular access (see 1c2.2)

- Cardiac (see 1c1.2)

- Abdomen (see 12.2)

- Musculoskeletal (see 8.2)

147

10. Cardiology


specialists of cardiology who perform echocardiography. The curriculum includes



Performance of supervised basic echocardiography prior to Level 1 certification.


Performance of unsupervised basic echocardiography. Basic echocardiography is easy

and effective basic assessment of haemodynamics. Basic echocardiography certification

should be obtained by all pre-specialists working in cardiology wards with assessment of

potentially acute or critically ill patients. At least Level 1 competence should be obtained

by anyone performing basic echocardiography unsupervised.


Specialists of cardiology who perform advanced echocardiography routinely. Level 2

certification should be obtained by all specialists of cardiology.


Specialists of cardiology who perform advanced echocardiography every working day and

most of the day, and who are active with echocardiography related science and teaching.

Only very few clinical specialists employing echocardiography obtain the expert

echocardiography level 3 certification. They are typically employed in university hospital

centers.



(2) Theory course of basic echocardiography


148

(4) Practical hands-on course of basic echocardiography

(2) Course exam in theory and practice of basic echocardiography

(3) Proctored practice (supervised procedures) of basic echocardiography

(4) Level 1 certification of basic echocardiography

(5) Unsupervised maintenance of basic echocardiography

(6) Theory & practice course of advanced echocardiography

(7) Course exam of advanced echocardiography

(8) Supervised procedures of advanced echocardiography

(9) Level 2 certification of advanced echocardiography - theory & practice

(10) Level 3 certification of expert echocardiography: Level 2 certified + minimum 500

advanced echocardiography exams per year for at least two years + teaching experience

within advanced echocardiography + minimum three echocardiography related scientific



Course







Ergonomics

Sterility

Safety

Administration

• Implementation of a basic echocardiography program

Sonoanatomy



149

o apical 4-chamber



aortic valve (base)

mitral leaflet tips

papillary muscles

Cardiac function



ejection fraction












Sonopathology

• Basic cardiac chamber dysfunction o dilated left atrium

o dilated left ventricle o dilated right atrium o dilated right ventricle o hypertrophy left ventricle


150

basic US diagnosis of cardiac tamponade

US guided pericardiocentesis • Pedunculated masses


• Hypovolemia


To be able to perform a basic echocardiography exam:


standard views • To recognise and differentiate between normal anatomy/physiology and pathology • To diagnose common abnormalities within the cardiovascular system • To recognize when a referral for a second opinion is indicated

• To understand the relationship between echocardiographic imaging and other

diagnostic imaging techniques • Perform basic echocardiographic hemodynamic monitoring of patient response to

interventions and diagnostics:

o Ventricular function Systolic function and wall motion abnormalities Diastolic function

o Hypovolemia and volume responsiveness o Tamponade and pericardial disease

o The sepsis syndromes o Effects of preload and afterload and assessment of filling status o Acute cor pulmonale o Hypoxemia

o Complications of acute MI o Chest trauma o Assessment of shock o Peri-resuscitation

o Failure to wean from mechanical ventilation o Hemodynamic measurements

151







- HOT 1



- HOT 2



- HOT 3







supervised basic echocardiography exams (TYPE A exams) + 25 autonomously




allow for understanding of dynamic phenomena (end-diastole/end-systole; end-

expiration/end-inspiration; M-mode)


CECLUS certified International Training Center (ITC) is required. Alternatively the 25

TYPE A exams can be replaced by 25 autonomously collected exams and internet

sharing with a distant tutor where the exams are uploaded and audited sequentially

152

one-by-one (a dedicated area will be activated on the CECLUS channel, with reserved

access to trainer’s page matched with distance tutor). Lack of information on single

cases, not allowing accurate judgement on trainees competence makes the case not

valid for final certification.




a distant tutor. Training in Cardiological Echo Labs is encouraged, especially to acquire

confidence with main TTE views. The basic echocardiographic exams should be

preferrably performed in patients with pathological hemodynamics.

• Case mix should include: LV dysfunction (ischemic and non ischemic), RV dysfunction

(acute cor pulmonale and ischemic), hypovolemia, vasoplegia, tamponade, cardiac

standstill, severe valvular disease.


trauma, AMI, pulmonary embolism, chronic cardiac disease (myocardial, valvular,

chronic cor pulmonale).








certification

Final Level 1 certification of basic echocardiography






153










• TTE on a real critical or cardially morbid patient (overall practical assessment, including

echocardiography-guided patient management)




technically competent in the execution of a basic echocardiography exam. Their clinical

competence in image integration into the critical or acute cardiac patient management

should though be certified by provision of minimum 30 documented exams (Logbook) +

exam on an acute cardiac patient + case discussion

10.3 Level 2

The training requisite to this level of practice would be gained during a period of cardiology

specialist training programme.








examinations within advanced echocardiography before Level 2 certification.


which should include ideally all Level 2 competencies for advanced

echocardiography.


sonopathology listed below.


advanced echocardiography examinations each year.


Practical Course






o contrast agents





155



o advanced echocardiography:

o systolic function






Doppler (PWD))






o pathology (lung embolus, acute coronary syndrome, papillary muscle

rupture, septic shock, chest trauma, complicated AMI, cardiac tamponade,

weaning failure from mechanical ventilation, acute valvular dysfunction)






o application of extended echocardiographic views

subcostal vena cava






suprasternal view


156




Left ventricle (LV) size

-‐ measured in PLAX view on frozen 2D or M-mode image

-‐ LV diastolic diameter (LVDd, cm)

-‐ LV diastolic diameter indexed for body surface area (BSA) (LVIDd, cm/m2)

-‐ LV systolic diameter (LVSd, cm)

-‐ LV mass (LVM, g)

-‐ LV mass indexed for body surface area (BSA) (LVMi, g/m2)

-‐ LV diastolic posterior wall thickness (PWTd, mm)

-‐ LV diastolic septal wall thickness (SWTd, mm)

Left ventricle geometry

-‐ normal geometry

-‐ concentric remodelling

-‐ excentric hypertrophy

-‐ concentric hypertrophy

-‐ Relative wall thickness (RWT)

Left ventricle systolic function

-‐ LV ejection fraction (LVEF)

-‐ Wall Motion Score Index (WMSI)

o normal

o hypokinesia

o akinesia

o dyskinesia

o ventricular aneyrism

-‐ Planimetry

Left ventricle diastolic function

-‐ measured in apical 4-chamber view with Pulsed Wave (PW) Doppler of mitral inflow

157

o PW tissue Doppler e’ lateral (cm/s)

o E/A ratio

o E/e’ ratio

o mitral deceleration time (ms)

Left atrium size

-‐ measured in PLAX end-systole

-‐ left atrial volume (ml)

-‐ left atrium volume index (ml/m2)

-‐ left atrium diameter (mm)

-‐ left atrium diameter index (mm/m2)

Right ventricle size

-‐ measured in apical 4-chamber view or RVOT (right ventricular outlet tract)

measured in PSAX (parasternal short axis view)

-‐ Right ventricular diastolic diameter (mm)

-‐ RVOT diameter (mm)

Right ventricle systolic function

-‐ measured in M-mode

-‐ Tricuspid annulus plane systolic excursion (TAPSE) (mm)

Aorta/truncus pulmonalis

-‐ aorta: measured in PLAX view in end-diastole (cm)

-‐ truncus pulmonalis: measured in PSAX (cm)

Inferior Vena Cava (IVC)

-‐ measured in the subcostal view

-‐ exspiratory diameter IVC (cm)

-‐ inspiratory collapse (%)

Aortic valve stenosis

-‐ Aortic valve area (AVA) (cm2)

-‐ Aortic valve peak velocity (m/s)

158

-‐ mean gradient (mmHg)

-‐ AVA indexed bsa (cm2/m2)

Mitral valve insufficiency

-‐ effective regurgitation orificium (ERO, cm2)

-‐ regurgitation volume (RV, ml)


o advanced echocardiography

o perform an advanced echocardiography exam


o estimate contractility (systolic function) of both ventricles


the left ventricle













Pulsed Doppler



159

10.4 Level 3


echocardiography and teaching, research and development within their subspecialized

field and will be an expert in this area.

10.5 Maintenance of Skills




Level 1: the practitioner should perform at least 100 basic TTE exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced TTE exams each

year.

Level 3: the practitioner should perform at least 400 basic and advanced TTE exams each

year.


• include echocardiography in their continued medical education (CME)




11. Lung Medicine Ultrasound 11.1 Introduction

This curriculum is intended for clinicians who perform lung medicine ultrasound (LMUS). It

includes standards for theoretical knowledge and practical skills.

Introductory level

Performance of supervised basic LMUS prior to Level 1 certification.

Level 1 (basic)

Performance of unsupervised basic LMUS. Basic LMUS: easy and effective LMUS for

management of acute pleural conditions. Basic LMUS certification (Level 1) should be

obtained by all specialists in lung medicine, preferably during their specialist training. At

least Level 1 competence should be obtained by anyone performing basic LMUS

unsupervised.

Level 2 (advanced)

Subspecialized lung medicine specialists who perform basic and advanced LMUS most

working days. Advanced LMUS: all LMUS procedures beyond basic LUS.

Level 3 (expert)

Expert who performs basic and advanced LMUS every working day and most of the day,

and who is active with science and teaching. Only very few clinical lung medicine

specialists obtain expert LMUS level. They are typically employed in a few university

hospital centers.


(1) Course pretest

(2) Theory course of basic LMUS


(4) Practical hands-on course of basic LMUS

161

(2) Course exam in theory and practice of basic LMUS

(3) Supervised procedures of basic LMUS

(4) Level 1 certification of basic LMUS

(5) Unsupervised maintenance of basic LMUS

(6) Theory & practice course of advanced LMUS

(7) Course exam of advanced LMUS

(8) Supervised procedures of advanced LMUS

(9) Level 2 certification of advanced LMUS - theory & practice

(10) Level 3 certification of expert LMUS: Level 2 certified + minimum 500 basic and

advanced LMUS procedures per year for at least two years + teaching experience within

advanced LMUS + minimum three scientific publications about LMUS in peer reviewed

papers


Course





Ergonomics

Sterility

Safety

Administration

Sonoanatomy

• Normal pleura

o lung sliding

o lung pulse


Sonopathology

• pneumothorax

162

• pleural effusion

• pleural empyema Level 1 Competencies to be acquired

To be able to:

• Perform a basic lung US exam • US guided pleural chest tube insertion







- HOT 1

o Basic LMUS views on normal models


- HOT 2

o Basic LMUS views on normal models or patients or sonosimulators


- HOT 3


- The course should be concluded with a course exam in theory and practice of basic

LMUS:





supervised basic LMUS exams (TYPE A exams) + 25 autonomously collected (TYPE B

163

exams, for later validation). All exams must be archived in digital format and data

collected in the logbook (excel file).

• When local tutors are not available, the 25 TYPE A exams can be replaced by 25

autonomously collected exams and internet sharing with a distant tutor where the

exams are uploaded and audited sequentially one-by-one (a dedicated area will be

activated on the CECLUS channel, with reserved access to trainer’s page matched

with distance tutor). Lack of information on single cases, not allowing accurate





a distant tutor.

• The following scenarios must be represented: Pneumothorax, pleural effusion, pleural

empyema, and ultrasound-guided insertion of a pleural chest tube.








certification

• Final Level 1 certification of basic LMUS








164











• LMUS exam on a healthy volunteer (assessment of technical skills in machine setting,


• LMUS on a real patient with pleural morbidity (overall practical assessment)


11.3 Level 2



programme.








examinations within advanced LMUS before Level 2 certification.


should include ideally all Level 2 competencies for advanced LMUS. An exam can

165

be a real clinical LMUS exam or a simulated LMUS exam. A minimum of 25 exams

have to be real clinical LMUS exams. • The theoretical and practical certification should encompass the full range of



examinations each year within advanced LMUS.


Practical Course








o advanced LMUS



pneumothorax

pleural effusion

rib fractures

interstitial syndrome

lung edema

ARDS

interstitial lung disease

respiratory distress syndrome

lung consolidation

pneumonia

lung embolus

atelectasis (compression, obstruction)

lung tumour

166

mediastinal staging of lung cancer

o complications

o safety


o basic and advanced LMUS exam

o Endobronchial ultrasound (EBUS) exam

o Endoscopic ultrasound (EUS) exam via esophagus

11.4 Level 3

A level 3 practioner is likely to spend the majority of their time undertaking LMUS and


in this area.





given in the text.


• include LMUS in their continued medical education (CME)




12. Ultrasound in Surgical Gastroenterology 12.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pre-specialists and

specialists of gastroenterology surgery who perform ultrasound in surgical

gastroenterology (USSG). The curriculum includes standards for theoretical knowledge

and practical skills.


Performance of supervised basic USSG prior to Level 1 certification.


Performance of unsupervised basic USSG. Basic USSG is easy and effective basic

assessment of basic acute gastroenterology conditions with ultrasound. Basic USSG

certification should be obtained by all specialists of gastroenterology surgery. At least

Level 1 competence should be obtained by anyone performing basic USSG unsupervised.


Subspecialized specialists who perform advanced USSG most working days. Level 2

certification is only obtained by few specialists in surgical gastroenterology.


Subspecialized experts who perform advanced USSG every working day and most of the

day, and who are active with endoscopic and laparoscopic ultrasound related science and

teaching. Only very few clinical experts employing USSG obtain the expert USSG level 3

certification. They are typically employed in university hospital centers.



(2) Theory course of basic USSG


(4) Practical hands-on course of basic USSG

168

(2) Course exam in theory and practice of basic USSG

(3) Proctored practice (supervised procedures) of basic USSG

(4) Level 1 certification of basic USSG

(5) Unsupervised maintenanc of basic USSG

(6) Theory & practice course of advanced USSG

(7) Course exam of advanced USSG

(8) Supervised procedures of advanced USSG

(9) Level 2 certification of advanced USSG - theory & practice

(10) Level 3 certification of expert USSG: Level 2 certified + minimum 500 advanced

USSG exams per year for at least two years + teaching experience within advanced

USSG + minimum three USSG related scientific publications in peer reviewed papers

(PhD level)


Course







Ergonomics

Sterility

Safety

Administration

Sonoanatomy


o Pleura

Anterior, bilateral


169

o Pericardium

o Peritoneum

Liver/right kidney

Spleen/left kidney


Urinary bladder

Abdominal aorta

Inferior vena cava

renal pelvis

gall bladder

Sonopathology

• pneumothorax

• pleural effusion • pericardial effusion • peritoneal effusion • urinary retention

• abdominal aortic aneyrism

• hydronephrosis

• gall bladder stones

• hypovolemia


To be able to:

• Perform an eFAST exam • US guided pleural chest tube insertion

• US guided peritoneal catheter insertion • US guided suprapubic catheter insertion • US guided peripheral venous access

170







- HOT 1

o Basic USSG views on normal models


- HOT 2

o Basic USSG views on normal models or patients or sonosimulators


- HOT 3



USSG:





supervised basic USSG exams (TYPE A exams) + 25 autonomously collected (TYPE









171




a distant tutor.

• The following scenarios must be represented: Pneumothorax, pleural effusion,

pericardial effusion, peritoneal effusion, urinary retention, abdominal aortic aneyrism,

hydronephrosis, gall bladder stones, pleural chest tube insertion, peritoneal catheter

insertion, and suprapubic catheter insertion.








certification

• Final Level 1 certification of basic USSG














172





• USSG exam on a healthy volunteer (assessment of technical skills in machine setting,


• USSG on a real patient with relevant morbidity (overall practical assessment)


12.3 Level 2



programme.








examinations within advanced USSG before Level 2 certification.


should include ideally all Level 2 competencies for advanced USSG. An exam can

be a real clinical USSG exam or a simulated USSG exam. A minimum of 25 exams

have to be real clinical USSG exams. • The theoretical and practical certification should encompass the full range of



examinations each year within advanced USSG.

173


Practical Course






o endoscopic US (EUS) examinations

o EUS guided celiacus blockade

o EUS guided cystogastrostomy

o EUS guided fine needle aspiration

o laparoscopic US (LUS) examination



o advanced USSG



o complications

o safety


To be able to perform:

o Perform endoscopic US (EUS) examinations safely and accurately and acquire all

standard views

o Perform EUS guided celiacus blockade safely and accurately and acquire all

standard views

o Perform EUS guided cystogastrostomy safely and accurately and acquire all

standard views

o Perform EUS guided fine needle aspiration safely and accurately and acquire all

standard views

o Perform laparoscopic US (LUS) examinations safely and accurately and acquire all

standard views

174

• To recognise and differentiate between normal anatomy/physiology and pathology


imaging techniques

12.4 Level 3


USSG and teaching, research and development within their subspecialized field and will

be an expert in this area. 12.5 Maintenance of skills




Level 1: the practitioner should perform at least 50 basic USSG exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced USSG exams

each year.

Level 3: the practitioner should perform at least 400 basic and advanced USSG exams

each year.


• include USSG in their continued medical education (CME)




13. Ultrasound of vascular surgery


specialists of vascular surgery who perform ultrasound of vascular surgery (UVS). The

curriculum includes standards for theoretical knowledge and practical skills.


Performance of supervised basic UVS prior to Level 1 certification.


Performance of unsupervised basic UVS. Basic UVS is easy and effective basic

assessment of basic vascular surgery conditions with ultrasound. Basic UVS certification

should be obtained by all specialists of vascular surgery. At least Level 1 competence

should be obtained by anyone performing basic UVS unsupervised.


Subspecialized specialists who perform advanced UVS many working days. Level 2

certification is only obtained by few specialists of vascular surgery.


Subspecialized experts who perform advanced UVS many working days, and who are

active with UVS related science and teaching. Only very few clinical experts employing

UVS obtain the expert UVS level 3 certification. They are typically employed in university

hospital centers.



(2) Theory course of basic UVS


(4) Practical hands-on course of basic UVS

(2) Course exam in theory and practice of basic UVS

176

(3) Proctored practice (supervised procedures) of basic UVS

(4) Level 1 certification of basic UVS

(5) Unsupervised maintenance of basic UVS

(6) Theory & practice course of advanced UVS

(7) Course exam of advanced UVS

(8) Supervised procedures of advanced UVS

(9) Level 2 certification of advanced UVS - theory & practice

(10) Level 3 certification of expert UVS: Level 2 certified + minimum 100 advanced UVS

exams per year for at least two years + teaching experience within advanced UVS +

minimum three UVS related scientific publications in peer reviewed papers (PhD level)


Course




• Scale

• Gain

• Filter

• Priority

• Angle correction

• Electronic steering

• Invert

• Sample gating

• Power output

• Colour amplitude

• Velocity measurement

• Spectral changes


• 2D ultrasound

• Power Doppler

177

• Pulsed wave Doppler

• Color wave Doppler

• Duplex

Ergonomics

Sterility

Safety

Administration


• peripheral extremity and pelvic arteries and veins

o Upper limb: subclavian, axillary, brachial, ulnar, radial

o Pelvic and lower limb: inferior vena cava, iliac, femoral, popliteal, major and

minor saphenous


• peripheral extremity arteries: patency, stenosis, occlusion, aneurismal dilatation

• peripheral extremity veins: patency, occlusion, deep venous thrombosis, reflux and

incompetence


To be able to:

• perform continuous wave hand-held Doppler and segmental pressures (ABPI)

• Upper and lower extremity peripheral arteries and grafts

• perform a complete imaging ultrasound examination of the axillary, brachial, radial,

and ulnar arteries

• perform a complete imaging ultrasound examination of the common iliac to femoral

and popliteal and calf arteries

• recognise and assess patency, occlusion, stenosis and aneurysmal dilatation, and

measure approximate extent of abnormality in lower extremity peripheral arteries

and grafts

• diagnose > 50% stenosis and assess the lenght of stenosis in lower extremity

peripheral arteries and grafts

• follow-up patients after surgical and endovascular procedures, recognise common

complications like arterio-venous (AV) fistulas and pseudoaneurysm formation

178

• recognise, diagnose and locate reflux

• identify the saphenofemoral and saphenopopliteal junctions

• recognise and locate clinically relevant venous reflux, incompetence and perforators



to be acquired listed below. The course should be minimum 24 hours duration at the




- HOT 1

o Basic UVS views on normal models


- HOT 2

o Basic UVS views on normal models or patients or sonosimulators


- HOT 3







the trainee should collect a minimum of 100 UVS exams under supervision: 50 fully

supervised basic UVS exams (TYPE A exams) + 50 autonomously collected (TYPE B







179































180










• UVS exam on a healthy volunteer (assessment of technical skills in machine setting,


• UVS on a real patient with relevant morbidity (overall practical assessment)


13.3 Level 2



programme.








examinations within advanced UVS before Level 2 certification.


should include ideally all Level 2 competencies for advanced UVS. An exam can be

a real clinical UVS exam or a simulated UVS exam. A minimum of 25 exams have

to be real clinical UVS exams.

181




Practical Course






o contrast enhanced ultrasound physics and examination




o abdominal aorta visceral arteries

o extracranial vessels


ultrasound)

o abdominal vessels: patency, occlusion, aneurysmal dilatation of aorta

o extracranial vessels: patency, occlusion, stenosis

o appearances and sequelae of common surgical or endovascular interventions

including angioplasty, stenting, grafts, Miller vein cuffs, dissections, and neointimal

hyperplasia

o complications

o safety




To be able to:


in Level 1

182

• in the upper and lower extremities, from common iliac to pedal vessels and

subclavian to radial and ulnar arteries and veins and to identify all kinds of non-

atherosclerotic diseases (vasculitides, compression syndromes, etc), as well as all

kinds of vascular malformation

• recognise and locate patency and occlusion of the abdominal aorta and large

visceral arteries (including renal arteries, superior mesenteric artery and celiac

trunk)

• recognise and size aneurysmal dilatation of the abdominal aorta large visceral

arteries

• recognise common normal variants, aneurysmal dilatation, patency, stenosis and

occlusion of the major abdominal and iliac vessels, including the mesenteric and

renal vessels

• recognise and locate patency, occlusion, plaque and stenoses in the carotid

vessels and vertebral arteries

• recognise and diagnose patency, occlusion, stenosis, reverse flow and steal in the

carotid and vertebral vessels

• grade degrees of carotid stenosis and plaque type in accordance with local criteria

and standards, and to follow-up patients after endarterectomy, carotid artery

stenting, and angioplasty

• perform vein mapping and marking

13.4 Level 3

A Level 3 practioner is likely to spend the majority of their time undertaking advanced UVS





specialised examinations including the use of non-invasive physiological studies, contrast

agents, intravascular or intra-operative ultrasound and ultrasound guided interventional

procedures (like US guide treatment of pseudonaeurysms, US guided RFA of varicose

veins, etc).

183







year.


year.


• include UVS in their continued medical education (CME)




14. Ultrasound of neurology


specialists of neurology who perform neurology ultrasound (NUS). The curriculum includes



Performance of supervised basic NUS prior to Level 1 certification.


Performance of unsupervised basic NUS. Basic NUS is easy and effective basic

assessment of basic neurologic conditions with ultrasound. Basic NUS certification should

be obtained by all specialists of neurology. At least Level 1 competence should be

obtained by anyone performing basic NUS unsupervised.


Subspecialized specialists who perform advanced NUS most working days. Level 2

certification is only obtained by few specialists of neurology.


Subspecialized experts who perform advanced NUS every working day and most of the

day, and who are active with NUS related science and teaching. Only very few clinical

experts employing NUS obtain the expert UVS level 3 certification. They are typically




(2) Theory course of basic NUS


(4) Practical hands-on course of basic NUS

(2) Course exam in theory and practice of basic NUS

185

(3) Proctored practice (supervised procedures) of basic NUS

(4) Level 1 certification of basic NUS - theory and practice

(5) Unsupervised maintenance of basic NUS

(6) Theory & practice course of advanced NUS

(7) Course exam of advanced NUS

(8) Supervised procedures of advanced NUS

(9) Level 2 certification of advanced NUS - theory & practice

(10) Level 3 certification of expert NUS


Course




• Scale

• Gain

• Filter

• Priority

• Angle correction

• Electronic steering

• Invert

• Sample gating

• Power output

• Colour amplitude

• Velocity measurement

• Spectral changes


• 2D ultrasound

• Power Doppler

• Pulsed wave Doppler

186

• Color wave Doppler

• Duplex

Ergonomics

Sterility

Safety

Administration


o extracranial vessels

o common carotid artery

o internal carotid artery

o external carotid artery

o vertebral artery

o intracranial vessels

o middle cerebral artery

o anterior cerebral artery

o posterior cerebral artery

o vertebral artery

o basilary artery

o internal carotid artery


o arterial stenosis

o arterial occlusion

o subclavian steal syndrome

o arterial plaques


To be able to:

o extracranial vessels:

o identify the vessels mentioned above

o identify patency, occlusion, stenosis

o grading of stenoses and evaluate pre- and post-stenotic flow

o subclavian steal syndrome

187

o intracranial vessels:

o identify the vessels mentioned above

o identify patency, occlusion, stenosis

o identify normal variants

o evaluate plaque morphology

o use contrast enhanced transcranial ultrasound







- HOT 1

o Basic NUS views on normal models


- HOT 2

o Basic NUS views on normal models or patients or sonosimulators


- HOT 3



NUS:





the trainee should collect a minimum of 200 intra- and extracranial NUS exams under

supervision: 100 fully supervised basic NUS exams (TYPE A exams) + 100

autonomously collected (TYPE B exams, for later validation). The last 100

autonomously performed exams can be validated either by: a) physical delivery of the

188

electronic logbook + digital clips/images on a mass storage device (CD/DVD/USB


a distant tutor. Training should usually be supervised by a level 2 practitioner. In certain

circumstances it may be appropriate to delegate some of this supervision to an

experienced level 1 practitioner with at least two years of regular practical experience.

When local tutors are not available, the 100 TYPE A exams can be replaced by







data collected in an electronic logbook (excel file). The documentation should record


imaging, image quality, and diagnostic performance. During the course of training a



exam can be a real clinical NUS exam or a simulated NUS exam: Didactic cases








Final Level 1 certification of basic NUS






189













• NUS exam on a healthy volunteer (assessment of technical skills in machine setting,


• NUS on a real patient with relevant morbidity (overall practical assessment)


14.3 Level 2



programme.








examinations within advanced UVS before Level 2 certification.

190


should include ideally all Level 2 competencies for advanced NUS.




Practical Course










ultrasound)

o identify advanced patterns of occlusion and stenosis

o advanced grading of stenoses and pre- and post-stenotic flow

o identify indirect signs of dissection of extracranial vessels

o evaluate complex flow abnormalities

o evaluate complex collateral formation

o complications

o safety




To be able to:


in Level 1 and 2.

191

14.4 Level 3

A Level 3 practioner is likely to spend the majority of their time undertaking advanced NUS





specialised examinations.

Level 3 certification requirements

Level 2 certified + minimum 400 advanced NUS exams per year for at least two years +

teaching experience within advanced NUS + minimum three NUS related scientific








year.


year.


• include UVS in their continued medical education (CME)




15. Ultrasound of general medicine

15.1 Introduction This curriculum is intended for CECLUS certification Level 1 of specialists of general

medicine who perform basic clinical ultrasound (BCU). The curriculum includes standards

for theoretical knowledge and practical skills. CECLUS has so far not defined Level 2 and

Level 3 of clinical ultrasound for general medicine.


Performance of supervised BCU prior to Level 1 certification.


Performance of unsupervised BCU. BCU is easy and effective basic assessment of basic

conditions in general medicine with ultrasound. BCU certification should be obtained by all

specialists of general medicine. At least Level 1 competence should be obtained by

anyone performing basic BCU unsupervised.



(2) Theory course of BCU


(4) Practical hands-on course of BCU

(2) Course exam in theory and practice of BCU

(3) Proctored practice (supervised procedures) of BCU

(4) Level 1 certification of BCU - theory and practice

(5) Performance of unsupervised BCU - maintenance

193


Course





• 2D ultrasound

• M mode

• Colour wave Doppler

Ergonomics

Sterility

Safety

Administration


• pleura/lung

• heart

• arteries

o aorta

o femoral artery

• veins

o inferior vena cava

o femoral vein

• diaphragm

• liver/gallbladder

• spleen

• kidneys

• intestines

• urinary bladder

• uterus

• musculoskeletal

o muscles/tendons

194

o bones

o joints

o subcutaneous tissue



• pneumothorax

• basic FATE (Focused Assessment with Transthoracic echocardiography)

• gallstones


• urinary bladder retention

• hydronephrosis

• peritoneal effusion

• hepatomegaly

• splenomegaly

• joint effusion

• joint aspiration

• joint injection

• abscess vs. phlegmon

• Deep venous thrombois (DVT) in the lower limb above the knee

• tendinitis

Other sonodiagnostics

• intrauterine pregnancy

• intrauterine device (IUD)


To be able to perform the following procedures with ultrasound guidance:

• diagnose pleural effusion

• diagnose pneumothorax

• the FATE protocol

• diagnose abdominal aortic aneurism (AAA)

• diagnose gallstones

• diagnose hydronephrosis

• diagnose joint effusion

195

• aspirate joint effusion

• joint injection

• differentiate subcutaneous abscess and phlegmon

• incision of abscess

• diagnose DVT above the knee

• diagnose tendinitis

• diagnose intrauterine pregnancy

• control IUD

• intravenous access







- HOT 1

o BCU views on normal models


- HOT 2

o BCU views on normal models or patients or sonosimulators


- HOT 3


The course should be concluded with a course exam in theory and practice of BCU:





the trainee should collect a minimum of 100 BCU exams under supervision: 50 fully

supervised basic BCU exams (TYPE A exams) + 50 autonomously collected (TYPE B


196




usually be supervised by an experienced level 1 practitioner with at least two years of

regular practical experience. When local tutors are not available, the 50 TYPE A exams

can be replaced by 50 autonomously collected exams and internet sharing with a

distant tutor where the exams are uploaded and audited sequentially one-by-one (a

dedicated area will be activated on the CECLUS channel, with reserved access to

trainer’s page matched with distance tutor). Lack of information on single cases, not


certification.







exam can be a real BCU exam or a simulated BCU exam: Didactic cases (provided

from local tutors and from distant tutors) should compensate for lack of an adequate

number of cases on some types of less frequent abnormalities. These should not be

reported in the logbook but rather listed, indicated separately as part of exam final

documentation. Sequential examinations on the same patients upon relevant




Final Level 1 certification of BCU






197













• BCU exam on a healthy volunteer (assessment of technical skills in machine setting,


• BCU on a real patient with relevant morbidity (overall practical assessment)





numbers of examinations to be performed annually to maintain skills certified at Level 1

are: the practitioner should perform at least 100 basic UVS exams each year.


• include BCU in their continued medical education (CME)




16. Ultrasound of geriatric medicine

16.1 Introduction This curriculum is intended for CECLUS certification Level 1 of specialists of geriatric

medicine who perform basic geriatric ultrasound (GUS). The curriculum includes standards

for theoretical knowledge and practical skills. CECLUS has so far not defined Level 2 and

Level 3 of clinical ultrasound for geriatric medicine.


Performance of supervised basic GUS prior to Level 1 certification.


Performance of unsupervised basic GUS. Basic GUS is easy and effective basic

assessment of basic conditions in geriatric medicine with ultrasound. Basic GUS

certification should be obtained by all specialists of geriatric medicine. Level 1 competence

should be obtained by anyone performing basic GUS unsupervised.



(2) Theory course of basic GUS


(4) Practical hands-on course of basic GUS

(2) Course exam in theory and practice of basic GUS

(3) Proctored practice (supervised procedures) of basic GUS

(4) Level 1 certification of basic GUS - theory and practice

(5) Performance of unsupervised basic GUS - maintenance

199


Course





• 2D ultrasound

• M mode

• Colour wave Doppler

Ergonomics

Sterility

Safety

Administration


• pleura/lung

• heart

• arteries

o aorta

o femoral artery

• veins

o IVC

o femoral vein

• diaphragm

• liver/gallbladder

• spleen

• kidneys

• intestines

• urinary bladder

• musculoskeletal

o muscles/tendons

o bones

200

o joints

o subcutaneous tissue



• pneumothorax

• basic FATE

• gallstones


• urinary bladder retention

• hydronephrosis

• FAST (focused assessment with sonography in trauma)

• peritoneal effusion

• hepatomegaly

• splenomegaly

• abscess vs. phlegmon


To be able to perform the following procedures with ultrasound guidance:

• diagnose pleural effusion

• diagnose pneumothorax

• the FATE protocol

• the FAST protocol

• diagnose AAA

• diagnose gallstones

• diagnose hydronephrosis

• differentiate subcutaneous abscess and phlegmon

• incision of abscess

• intravenous access




201




- HOT 1

o Basic GUS views on normal models


- HOT 2

o Basic GUS views on normal models or patients or sonosimulators


- HOT 3


The course should be concluded with a course exam in theory and practice of basic GUS





the trainee should collect a minimum of 100 basic GUS exams under supervision: 50

fully supervised basic GUS exams (TYPE A exams) + 50 autonomously collected

(TYPE B exams, for later validation). The last 50 autonomously performed exams can

be validated either by: a) physical delivery of the electronic logbook + digital

clips/images on a mass storage device (CD/DVD/USB stick) to the assigned tutor once

the collection is completed; b) by internet sharing with a distant tutor. Training should

usually be supervised by an experienced level 1 practitioner with at least two years of

regular practical experience. When local tutors are not available, the 50 TYPE A exams

can be replaced by 50 autonomously collected exams and internet sharing with a

distant tutor where the exams are uploaded and audited sequentially one-by-one (a

dedicated area will be activated on the CECLUS channel, with reserved access to

trainer’s page matched with distance tutor). Lack of information on single cases, not


certification.

202







exam can be a real basic GUS exam or a simulated basic GUS exam: Didactic cases








Final Level 1 certification of basic GUS















203




• Basic GUS exam on a healthy volunteer (assessment of technical skills in machine


• Basic GUS on a real patient with relevant morbidity (overall practical assessment)





numbers of examinations to be performed annually to maintain skills certified at Level 1

are: the practitioner should perform at least 100 basic GUS exams each year.


• include basic GUS in their continued medical education (CME)




17. Medical Gastroenterology Ultrasound 17.1 Introduction This curriculum is intended for CECLUS certification Level 1-3 of pre-specialists and

specialists of medical gastroenterology who perform medical gastroenterology ultrasound

(MGUS). The curriculum includes standards for theoretical knowledge and practical skills.


Performance of supervised basic MGUS prior to Level 1 certification.


Performance of unsupervised basic MGUS. Basic MGUS is easy and effective basic

assessment of basic gastroenterology conditions with ultrasound. Basic MGUS

certification should be obtained by all specialists of medical gastroenterology. At least

Level 1 competence should be obtained by anyone performing basic MGUS unsupervised.


Subspecialized specialists who perform advanced MGUS most working days. Level 2

certification is only obtained by few specialists of medical gastroenterology.


Subspecialized experts who perform advanced MGUS every working day and most of the

day, and who are active with MGUS related science and teaching. Only very few clinical

experts employing MGUS obtain the expert MGUS level 3 certification. They are typically




(2) Theory course of basic MGUS


(4) Practical hands-on course of basic MGUS

(2) Course exam in theory and practice of basic MGUS

205

(3) Proctored practice (supervised procedures) of basic MGUS

(4) Level 1 certification of basic MGUS

(5) Unsupervised maintenanc of basic MGUS

(6) Theory & practice course of advanced MGUS

(7) Course exam of advanced MGUS

(8) Supervised procedures of advanced MGUS

(9) Level 2 certification of advanced MGUS - theory & practice

(10) Level 3 certification of expert MGUS: Level 2 certified + minimum 500 advanced

MGUS exams per year for at least two years + teaching experience within advanced

MGUS + minimum three MGUS related scientific publications in peer reviewed papers

(PhD level)


Course







Ergonomics

Sterility

Safety

Administration

Sonoanatomy


o Pleura

Anterior, bilateral


o Pericardium

206

o Peritoneum

Liver/right kidney

Spleen/left kidney


Urinary bladder

adrenal glands

Abdominal aorta

Inferior vena cava

renal pelvis

gall bladder/bile ducts

pancreas

Sonopathology

• pneumothorax • pleural effusion • pericardial effusion • peritoneal effusion

• urinary retention


• hydronephrosis

• renal enlargement

• renal processes

• gall bladder stones

• cholecystitis

• gall bladder tumours

• bile duct obstruction

• liver cysts

• liver processes

• fatty liver change

• liver cirrhosis

• pancreatitis

• pancreatic duct stones

207

• pancreatic duct dilatation

• pancreatic processes

• splenic enlargement

• portal venous distension

• portal venous thrombosis

• uterine processes

• intrauterine pregnancy

• hypovolemia


To be able to:

• Perform an eFAST exam • Recognize normal sonoanatomy (see above)

• Diagnose relevant sonopathology (see above) • US guided pleural chest tube insertion • US guided peritoneal catheter insertion • US guided suprapubic catheter insertion

• US guided vascular access Level 1 Theoretical & Practical Course






- HOT 1

o Basic MGUS views on normal models


- HOT 2

o Basic MGUS views on normal models or patients or sonosimulators


- HOT 3

208



MGUS:





supervised basic MGUS exams (TYPE A exams) + 25 autonomously collected (TYPE












a distant tutor.

• The following scenarios must be represented: all the sonopathological conditions listed

above.








certification

209

• Final Level 1 certification of basic MGUS


















• MGUS exam on a healthy volunteer (assessment of technical skills in machine setting,


• MGUS on a real patient with relevant morbidity (overall practical assessment)


17.3 Level 2



programme.

210








examinations within advanced MGUS before Level 2 certification.


should include ideally all Level 2 competencies for advanced MGUS. An exam can

be a real clinical MGUS exam or a simulated MGUS exam. A minimum of 25 exams

have to be real clinical MGUS exams. • The theoretical and practical certification should encompass the full range of



examinations each year within advanced MGUS.


Practical Course






o endoscopic US (EUS) examinations

o EUS guided celiacus blockade

o EUS guided fine needle aspiration



o advanced MGUS



211

o complications

o safety


To be able to perform:

o Perform endoscopic US (EUS) examinations safely and accurately and acquire all

standard views

o Perform EUS guided celiacus blockade safely and accurately and acquire all

standard views

o Perform EUS guided fine needle aspiration safely and accurately and acquire all

standard views

• To recognise and differentiate between normal anatomy/physiology and pathology • To diagnose common abnormalities

• To recognize when a referral for a second opinion is indicated • To understand the relationship between ultrasound imaging and other diagnostic

imaging techniques

17.4 Level 3


MGUS and teaching, research and development within their subspecialized field and will

be an expert in this area. 17.5 Maintenance of skills




Level 1: the practitioner should perform at least 50 basic MGUS exams each year.

Level 2: the practitioner should perform at least 200 basic and advanced MGUS exams

each year.

Level 3: the practitioner should perform at least 400 basic and advanced MGUS exams

each year.

212


• include MGUS in their continued medical education (CME)




18. Contacts

Specialty Name Department E-mail CECLUS Lars Bolvig Dep. Radiology, AUH [email protected] CECLUS Thomas F Bendtsen Dep. Anesthesiology, AUH [email protected] CECLUS Peder Charles Center of Medical Education [email protected] Exp. & Clin. Research Kristjar Skajaa Clinical Institute, FH, AU [email protected] Medico-technology Carsten Riis Dep. medico-technology, AUH [email protected] Skill training Kurt Nielsen Skill training lab., AUH Medical imaging Hans Nygaard Clinical Institute, FH, AU [email protected] Anesthesiology Erik Sloth Dep. Cardiothor Anesth, AUH [email protected] Anesthesiology Lars Knudsen Dep. Anesthesiology, AUH [email protected] Cardiology US Steen H Poulsen Dep. Cardiology, AUH [email protected] Cardiology US Susanne Aagaard Dep. Cardiology, AUH [email protected] Dermatology US Karsten Fogh Dep. Dermatology, AUH [email protected] Endocrinology US Eva Ebbehøj Dep. Endocrinology, AUH [email protected] Endocrinology US Søren Gregersen Dep. Endocrinology, AUH [email protected] Gastroenterol medicine US Jens Dahlerup Dep. gastroenterol med, AUH [email protected] Gastroenterol medicine US Søren Lyhne Dep. gastroenterol med, RHR [email protected] Gastroenterol medicine US Martin Eivindson Dep. gastroenterol med, RHH [email protected] Gastroenterol surg US - - - Geriatric medicine US Bjørn Mathiassen Dep. Geriatrics, AUH [email protected] Geriatric medicine US Anne B Pedersen Dep. Geriatrics, AUH [email protected] General medecine US Martin Bach Jensen Institute of Public Health, AUH [email protected] General medecine US Søren Olsson MEDU, AUH [email protected] Gynecological US Olav Bjørn Petersen Dep. Obstetrics & Gynaecology [email protected] Infectious Diseases US Peter Leutscher Dep. Infectious Medicine, AUH [email protected] Infectious Diseases US Hanne Arildsen Dep. Infectious Medicine, AUH [email protected] Lung medicine US Birgitte Folkersen Dep. Lung Medicine, AUH [email protected] Lung medicine US Ole Hilberg Dep. Lung Medicine, AUH [email protected] Neurology US Paul von Weitzel Dep. Neurology, AUH [email protected] Orthopedic surgery US Svend E Christiansen Dep. Orthopedic Surgery, AUH [email protected] Orthopedic surgery US Kjeld Søballe Dep. Orthopedic Surgery, AUH [email protected] Orthopedic surgery US Claus Möger Dep. Orthopedic Surgery, AUH [email protected] Orthopedic surgery US Peter Faunø Dep. Orthopedic Surgery, AUH [email protected] Orthopedic surgery US Hans V Johansen Dep. Orthopedic Surgery, AUH [email protected] Otorhinolaryngology US Sten Schytte Dep. otorhinolaryngol., AUH [email protected] Otorhinolaryngology US Thomas Barrett Dep. otorhinolaryngol., AUH [email protected] Pediatrics US Tine B Henriksen Dep. Pediatrics, AUH [email protected] Plastic surgery US Tine Damsgaard Dep. Plastic Surgery, AUH [email protected] Rheumatology US Ulrik Fredberg Dep. Rheumatology, RHS [email protected] Thoracic surgery US Mariann Tang Dep. Thoracic Surgery, AUH [email protected] Urology US - - - Vascular surgery US Nikolaj Eldrup Dep. Vascular Surgery, AUH [email protected]

standards of certification · responsibility of the trainee to ensure that their practical skills...

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