Sonodynamics in a nutshell:
Scanning through structures is the basis for all ultrasound. All examiners use their own more or less structured scanning protocols by which they automatically move the transducer as an extension of their eyes while looking for pathology. Sonodynamics is simply an attempt of agreeing upon a systematic "skeleton" of predefined scans, where the scans themselves are filmed instead of snapshots of findings. After some weeks of adaptation, any ultrasonographer easily scans and takes cine clips in the predefined fashion while examining the patient. Pathology is captured and stored by these filmed cineclips as well as by our eyes. And better, pathology that we oversee bedside because we are inexperienced, focused on a specific question, or simply tired, is also captured by the films. This fact is invaluable in ultrasound training, re-evaluation of exams and for comparison with previous exams in a setting with fast ultrasound workstations. In all other aspects Sonodynamics is the same as any ultrasound, with additional small cineclips of bedside findings. Hence, the goal of Sonodynamics is to make everyday ultrasound open for re-evaluation in the way all other modalities within radiology are. Ultrasound has a lot to win by adding full cine documentation to the written reports.
What is Sonodynamics?
The word “Sonodynamics” is an umbrella term that covers:
1. Standardized scanning in ultrasound by the use of “Sonoexams”.
2. Evaluation of such exams at workstations.
3. Non-destructive storage of the entire Sonoexams.
4. The ability to retrieve the exams from the archive for later scrutiny.
5. The ability to compare previous exams with new ones.
Why should I use Sonodynamics?
In order to provide as unbiased documentation as possible.
For efficient training and surveillance in ultrasound training.
To enable true comparison between new and previous exams.
To prove abscense of lesions, which cannot be done with still images or ever so detailed reports.
To prove the appearance of new lesions in previously unaffected areas.
Still not convinced? More arguments!
What are Sonoexams?
A Sonoexam is a predefined pattern of “Sonoscans”.
The simplest and fundamental Sonoexam consists of only two Sonoscans: One downward Sonoscan in the transversal scan plane, followed by a Sonoscan left-to-right in the sagittal scan plane.
Different organs and more complex structures have their own custom made Sonoexams.
The goal is to present the target organ on the monitor and workstation according to its predefined Sonoexam.
What is a Sonoscan?
A Sonoscan by definition is a scan in one direction at a steady pace.
Each Sonoscan takes 5 – 15 seconds.
Sonoexams are built on a number of individual, predefined Sonoscans.
Some Sonoscans are special:
The “fanning” Sonoscan sometimes used in the arterial phase of CEUS.
The “tracing” Sonoscan used to follow the transverse plane of a tortuous aorta or the colon.
The “still” Sonoscan used for documentation of gut movement or other moving structures.
What is the basis for the design of “custom made” Sonoexams?
The normal shape and position of the organ to be examined, in order to cover all of it.
However, the examiner has to be able to add Sonoscans if the anatomy so requires.
Small structures without their "own" scanning pattern are scanned according to the basics of Sonodynamics.
The experienced sonographer or sonologist can apply sonodynamics to clarify anatomy and pathology at workstation.
What are the advantages of Sonodynamics?
There is much more information in the scans than is sometimes perceived bedside.
Often pathology that has been overlooked bedside can be seen at workstation later (in our experience much more is discovered than missed by capturing the entire scans).
Areas of difficult anatomy are easier to assess by scrutiny of dynamic clips.
In CEUS, as in US, it makes for higher diagnostic quality.
It enables comparison between exams over time, almost regardless of different examiners.
Very efficient in education.
Worthwhile comparisons with CT and MRI exams.
Fast scanning once the technique is learned and fully implemented in ALL exams.
More meaningful demonstrations.
What are the disadvantages?
The need for equipment that can easily store dynamic clips, as well as fast workstations.
There is a learning curve before feeling comfortable performing standardized scans while making diagnostic decisions bedside.
Some subtle pathology may be overlooked by standardized clips alone (mostly depending on the skills of the scanner).
How do Sonoexams impact clinical workflow?
The workflow in the US department becomes more similar to radiological workflow.
More efficient and secure education, since skills and progress can be monitored at workstation.
Pathology can usually be discussed and re-evaluated without the need for another exam.
Sonotechnicians can scan the "bulk" of US exams for later reading by sonologists at workstations.
Sonologists can re-read off-hour exams and make corrections to the reports as necessary.
Clinicians can scan defined structures (i.e. neonatal brains) for reporting by sonologists at workstations.