©Owen Brown's Workshops in Cardiac and Vascular Ultrasound®

Detailed Course Descriptions for Physicians — 2022

CARDIAC ANATOMY AND PHYSIOLOGY FOR PHYSICIANS (one day)

One of the key problems facing those who are interested in cardiac ultrasound is a familiarity with detailed three dimensional cardiac anatomy.  Even those individuals who are very comfortable with cardiac circulation have seldom been forced into a position of actually conceptualizing the three dimensional geometry of the heart because relatively few job specialties require day to day use of such information. Add to this the fourth dimension of time and the problem becomes magnified. The situation would pose a difficult enough problem if all that were needed was such familiarity with a normal heart. The necessity for those reading cardiac ultrasound to also have a working knowledge of abnormal cardiac anatomy and the effects that various disease states have on other parts of the heart makes it easy to understand the initial confusion as people attempt to integrate the various ultrasound modalities (M mode, 2D and Doppler). Our Cardiac Anatomy and Physiology course is approximately six hours of intense review which is designed to give those attending the tools necessary to quickly develop the anatomical orientation to more successfully image the heart and to understand the extent of the lesions found by observing chamber size, wall thickness and cardiac output status. This session is offered immediately prior to the Level One and Level Two Cardiac Ultrasound Programs.  Those physicians without current, active cath lab background usually find the program to be beneficial.

LEVEL ONE CARDIAC ULTRASOUND FOR PHYSICIANS

Effective February, 2004, Internists and Radiologists new to cardiac ultrasound attend Level Two Cardiac Ultrasound for Physicians plus Level Two Physician Supplement and Standard Cardiac Doppler for Physicians. This schedule replaces Level One for Physicians plus Standard Cardiac Doppler for Physicians. The change reflects improved clinical cardiology background levels of physician attendees since January, 2000.

LEVEL TWO CARDIAC ULTRASOUND FOR PHYSICIANS (4 days)

This program is designed for Internists, Radiologists and General Practitioners who wish to improve or develop skills in cardiac ultrasound. Most physicians attending fall into one of two background groups: (1) good clinical background in cardiology, but insufficient formal training in cardiac ultrasound to interpret and/ or conduct cardiac ultrasound competently as defined by national consensus or (2) good clinical background in cardiology and previous exposure to interpreting cardiac ultrasound exams, but insufficient exposure to interpret and/or conduct exams at a skill level they believe to represent “sufficient” matched against their own potential (some physicians in this background group actually repeat this class every 4 or 5 years as a “refresher course” due to limited types of pathology seen in their practice and/or limited number of studies they interpret in their practice).

In terms of prerequisites, those who fall into the first background group described above must also complete the Level Two Physician Supplement described below (as a general rule, those who previously completed the Level One Cardiac Ultrasound for Physicians program conducted by Owen Brown Workshops — offered prior to February 1, 2004 — do not need the Level Two Physicians Supplement, but may feel it useful in their own clinical circumstance). The Standard Cardiac Doppler program which follows the Level Two Cardiac Ultrasound program is also strongly recommended for those in the first background group (the Supplemental/Intermediate Cardiac Doppler program is far too advanced to be productive for those who fall into the first background group). Those who fall into the second background group can complete the Level Two Physicians Supplement if they feel it useful in their own clinical circumstance.  Further, those who fall into the second background group should also complete either the Standard Cardiac Doppler program or the Supplemental/Intermediate Cardiac Doppler program if their schedule permits. Physicians without adequate clinical cardiology background should not take the Level Two Cardiac Ultrasound for Physicians program.

In terms of daily schedule, one half of the day is spent in a formal Lecture environment, one fourth of the day is spent in a “hands on” session operating equipment under Staff supervision and one fourth of the day is spent reviewing edited case studies with Staff to apply the information reviewed during the lecture session (physicians may elect to review additional case studies rather than participate in the “hands on” session if it better fits their clinical circumstances).

In terms of academic content, measurement parameters are reviewed utilizing both M mode and 2D techniques. While M mode criteria for primary valvular diseases are reviewed and compared with 2D parameters, the Level Two Cardiac Ultrasound Program emphasizes 2D parameters (see “Level Two Physician Supplement” described below). Substantial review of 2D assessment of both segmental disease and general output status is provided. Emphasis is placed on data quality, structural and planal orientation, anatomical orientation and interpretative pitfalls (both operator and conceptual). Assessment and use of physiological effects to detect and quantitate valvular disease is reviewed in detail and heavily emphasized.  Those completing the program will find that it greatly enhances their ability to understand the role that cardiac ultrasound studies play in practical, realistic, clinically worthwhile evaluation of overall cardiac status. Some physicians who fall into the second background group described above also utilize this program in preparation for completing a physician certification exam in cardiac ultrasound, while others take the course simply to improve their skills in the field. The Level Two Program for physicians is objectively evaluated by two quizzes.  Physicians who successfully complete the exams will receive a “certificate of completion” while those who do not complete the quizzes will receive a “certificate of participation”.

Physicians Supplement for Level Two Cardiac Ultrasound for Physicians
 
This course is designed for physicians who are completing the Level Two Cardiac Ultrasound for Physicians program but are relatively inexperienced in the field. The session offers an opportunity to review in detail parameters which are sometimes already familiar to Level Two Cardiac Ultrasound participants with more than 500 interpretations under their belt. Topics include a more detailed comparison of all M mode versus 2D measurements, a more detailed review of all valvular interpretation parameters (as well as their pitfalls) and a more detailed review of 2D planal orientation in standard views than conducted during the regular class time of the Level Two Cardiac Ultrasound Program.

In terms of those who should complete the class, this session is required for physicians completing the Level Two Cardiac Ultrasound program who have not yet interpreted at least 300 confirmable cardiac ultrasound studies (previous completion of either the Level One or Level Two Cardiac Ultrasound for Physicians programs from Owen Brown Workshops or an equivalent program approved by Owen Brown Workshops can be substituted for this requirement).  Any physician completing the Level Two program with a considerably higher level of experience is welcome to attend the session if they feel the information would be of benefit in their clinical circumstance. Only physicians who are taking the Level Two Cardiac Ultrasound program for physicians may attend this session.

In terms of daily schedule, the class is conducted as early morning and afternoon sessions which are held daily outside of the regular Level Two class hours.

ECHOCARDIOGRAPHER UPDATE FOR PHYSICIANS (1 or 2 days) – new

This Course is designed for individuals wo feel they have good skills in Echocardiography but who also want a solid review of practical ways to select the most valid/applicable of several Doppler Parameters by comparison with physiological effects.  Detailed review of most likely technical errors are also reviewed.

Part 1 of the course (1 day in duration) reviews the most current interpretative and quality control aspects of evaluating physiological effects and other 2D parameters.

Part 2 of the Course (1 day in duration) reviews key cardiac Doppler parameters (see sample lecture topics below after the Standard Doppler description.

STANDARD CARDIAC DOPPLER FOR PHYSICIANS (2.5 days)

Substantial confusion and misunderstanding about the practical, clinical utility of cardiac Doppler exists in cardiac ultrasound labs throughout most of the western world. While it is clear that Doppler can usually detect most forms of valvular regurgitation, its ability to quantitate any form of valvular heart disease is very dependent upon not only technical problems (such as gain, beam vs. jet angle, number, size and shape of holes, etc.), but also upon contamination produced by coexisting valvular lesions, cardiac output status and other variables. Those individuals with extensive Doppler background know that for every diagnostic criteria in Doppler, there are several different disease states that will mimic the criteria.  This session is designed to provide those attending with a practical working knowledge of both spectral and color Doppler.  Emphasis is placed on integration of the Doppler with the 2D and M mode studies so as to place into perspective Doppler’s role in correlating to the physiological effects that various types of valvular disease have on the walls, chambers and great vessels of the heart (i.e., matching the amount of ventricular hypertrophy to the Doppler estimate of AS severity so as not to underestimate severity of AS due to technical problems associated with the angle of jet versus the Doppler beam angle, etc.). Those attending usually find the audiovisual lab to also be an excellent 2D and M mode interpretative review.

In terms of prerequisites, the need to correlate information produced by 2D and M mode with the Doppler coupled with the relatively short duration of the Doppler program dictates that those who attend have significant 2D and M mode background. Those who have previously completed (or who are currently taking) our Level One and/or Level Two Cardiac Ultrasound program will do well with the Doppler data reviewed.  Those without experience in our cardiac ultrasound programs should have interpreted at least 300 cardiac ultrasound cases to benefit properly from the Doppler course material. Should any question exist regarding background of a prospective student, we recommend that you contact this Office prior to enrollment.

In terms of daily schedule, three hours a day are spent in a lecture format which reviews Doppler interpretative parameters and their pitfalls (both conceptual and practical), 2 hours a day are spent in a “hands on” session to provide practical technical experience in obtaining Doppler data from hired subjects and two hours a day are spent in an audiovisual lab with our Staff to review edited case studies.

Dynamics of Blood Flow Session for Standard Cardiac Doppler for Physicians

While conduction and/or interpretation of echocardiograms certainly improves familiarity with how walls and valves of the heart move, it fails to provide adequate background in the conceptualization of how blood actually moves as “seen” by a Doppler machine. This session is designed to familiarize participants with the relationship between pressure and velocity, Doppler turbulence at various points in normal hearts and the characteristics of blood flow (both in terms of speed and turbulence) which can be anticipated in various types of valve disease, shunt flow and prosthetic devices. Detailed reviews of flow timing in multiple pathologies is provided (i.e., timing to differentiate left-to-right shunt flow in an ASD versus venae cava flow or timing the onset of diastolic turbulence in the LVOT to differentiate between AR and opening of the mitral valve, etc.).  Emphasis is also placed on those pathologies which result in Doppler flow patterns that could be mistaken for several different disease states at the same time. The program is required for all physicians who complete the Level Two Cardiac Ultrasound for Physicians program who wish to complete the Standard Cardiac Doppler program at the same time they complete the Level Two program unless they have previously completed the Level One Cardiac Ultrasound for Physicians by Owen Brown Workshops (offered prior to February, 2004).  This program is strongly recommended for anyone who completes the Standard Cardiac Doppler program unless they have current, active cardiac cath lab background.

In terms of daily schedule, the program begins at 10:45 am and ends at approximately 1:00 p.m. The class is conducted in a lecture format.

Optional Extended “Hands On” Session for Standard Cardiac Doppler for Physicians

While some physicians attending the Standard Cardiac Doppler program have substantial background in actually producing cardiac ultrasound studies (or don’t want any such background), others may be relatively new to the ultrasound field and seek such background to perform the studies or because they believe such background ultimately aides their ability to recognize technical errors in the data (and thereby improve their ability to interpret the data). In order to provide an opportunity for more extensive review of probe technique as specifically related to Doppler, an extended Doppler probe session of approximately three hours in duration is available immediately after the regular Standard Cardiac Doppler Course.

ECHOCARDIOGRAPHER UPDATE FOR PHYSICIANS (1 or 2 days) – new

This Course is designed for individuals wo feel they have good skills in Echocardiography but who also want a solid review of practical ways to select the most valid/applicable of several Doppler Parameters by comparison with physiological effects.  Detailed review of most likely technical errors are also reviewed.

Part 1 of the course (1 day in duration) reviews the most current interpretative and quality control aspects of evaluating physiological effects and other 2D parameters.

Part 2 of the Course (1 day in duration) reviews key cardiac Doppler parameters.

Some of the Doppler Lecture titles currently scheduled for 2019 are:

Quantitation of Mitral Regurgitation — Multiple Criteria Must Agree — No One Criteria is Reliable Enough to Stand Alone.  Specific topics covered include physiological effects, vena contracta size, color Doppler “mapping”, PISA, signal intensity and calculation of percentage regurgitant volume.  Changes in flow related to cardiac output status, conceptual pitfalls and technical challenges of the various quantitative parameters reviewed are emphasized.

Diastolic Dysfunction of the Left Ventricle — Points of Agreement and Disagreement within the Echocardiography Community.  Specific topics covered include LA volume (and other physiological effects), Doppler of mitral inflow, pulmonary vein flow, tissue Doppler (TDI) and IVRT.  Changes in flow related to cardiac output status, conceptual pitfalls and specific technical challenges of the various quantitative parameters reviewed are emphasized.

Quantitation of Aortic Stenosis — the Importance of LVOT Size, Cardiac Output Status and Physiological Effects (“it’s not just aortic valve velocity”).  Specific topics covered include physiological effects, aortic orifice area, peak gradient, mean gradient and other pathologies associated with significant aortic stenosis.  Changes in flow related to cardiac output status, conceptual pitfalls and specific technical challenges of the various quantitative parameters are reviewed.  Great emphasis is placed on the multiple views needed to find the highest aortic valve velocity, accurate LVOT VTI, the critical importance of accurate LVOT size and the relationship of small changes in combinations of these measurements in moderate or severe Aortic Stenosis with aortic valve velocities at or below 3.0 meters/second.

Doppler Quantitation of Right Heart Hypertension — the Role of Tricuspid Regurgitation, Pulmonic Regurgitation, Pulmonic Valve Acceleration Time and Criteria for IVC “Sniff”, Right Atrial and Right Ventricular size.  Specific topics covered include physiological effects of pulmonary hypertension, estimation of RV systolic pressure utilizing TR velocity, estimate of diastolic pulmonary artery pressure utilizing end diastolic velocity of pulmonic regurgitation and estimation of systolic pulmonary artery pressure utilizing pulmonic valve acceleration time.  Changes in flow related to cardiac output status, conceptual pitfalls and specific technical challenges of the various quantitative parameters reviewed are emphasized.

    In terms of prerequisites, Parts 1 and 2 are designed for individuals with good cardiac ultrasound skills.  Those who have previously completed our Level One, Level Two and/or Level Three Cardiac Ultrasound Programs during the last 10 years will find the Course to be a very useful update which is actually related to their clinical work (such participants receive a 50% tuition discount).  The class is also appropriate for Physicians who have interpreted at least 1,000 echocardiograms.  Should any questions regarding prerequisites arise, please contact our Office prior to enrollment.

CERTIFICATION REVIEW FOR PHYSICIANS

Physicians preparing to take some form of competency exam in cardiac ultrasound will find either the Level Two Cardiac Ultrasound program (usually taken in conjunction with the Standard Cardiac Doppler or Echocardiographer Update) to be very useful.

INTRODUCTION TO CAROTID DUPLEX FOR PHYSICIANS (2.5 days)

This course is designed to serve as an introduction to both the technical and interpretative aspects of carotid duplex. The session reviews the utility of imaging, spectral Doppler and color Doppler to detect and quantitate carotid stenosis and plaque. The program rejects those parameters which have historically resulted in a huge false positive rate and inaccurate estimates of percentage stenosis. The relationship between cardiac status and carotid flow is heavily emphasized (i.e., the effect of AS, AR and high vs. low cardiac output on carotid flow). A review of high velocity Doppler flow principals (in contrast to low velocity flow) and the quality control parameters necessary to insure accurate Doppler estimates of speed and turbulence is provided.

In terms of daily schedule, approximately three hours a day are spent in lecture format reviewing pertinent anatomy, interpretative parameters and their pitfalls, two hours a day are spent reviewing edited case studies with Staff applying the parameters reviewed in Lecture and two hours a day are spent in a “hands on” environment conducting carotid studies on hired subjects.

In terms of prerequisites, those with background in cardiac ultrasound will find the program extremely useful. Those individuals who have been involved with carotid studies previously but have little or no formal training in cardiac ultrasound and/or evaluation of high velocity Doppler flow will also find the program extremely useful. Those individuals with background in general ultrasound imaging other than the heart and/ or carotids usually find the course appropriate; however, they need to pay particularly close attention to the principals of Doppler flow and its quality control which are presented in the first lecture session. The program is generally not recommended for those individuals who have no background in any form of ultrasound imaging (the exception to this rule would be physicians with extensive clinical background in carotid disease and/or cardiac hemodynamics). Should any questions arise in this regard, please contact this Office prior to enrollment.

ABDOMINAL AORTA, PERIPHERAL ARTERIES, RENAL ARTERIES + KIDNEYS and UPPER EXTREMITY IMAGING and DOPPLER FOR TECHNOLOGISTS (2 days)

This course is designed to serve as an introduction to both the technical and interpretative aspects of vascular ultrasound in the upper extremities other than the Carotids (see above).  The session reviews the utility of imaging, spectral Doppler and color Doppler to detect and quantitate vascular disease in the areas noted above. The daily schedule and prerequisites for this portion of our general vascular program are the same as for the carotid program outlined above; however, participants in this portion of the vascular program must have background in performing and/or interpreting Carotid Duplex studies in order to make maximum use of the information covered. In this regard completion of our Carotid Duplex program outlined above is ideal preparation for our general vascular course; however, past experience in carotid studies should be sufficient assuming a good background in Doppler (reviewed in the Carotid course outlined above).

 
Owen R. Brown, Program Director

PO Box 2430

Portland, OR 97208

USA

Phone: (503) 655-9191
E-mail: owenbrown@owenbrownworkshops.com