Veterinary Ultrasound Certification Program


The goal of this program to provide a structured training environment that allows a small animal veterinarian to reach a defined level of ultrasonography expertise. Veterinarians who are utilizing ultrasound as an integral part of diagnostic work ups on a daily basis and desire credentials to reflect their expertise are especially suited. The credentialing and examination process necessary for IVUSS certification program is both highly challenging and rewarding.

The program combines the traditional short courses listed below with two additional training tools. The first is the requirement for presentation of casebooks in 1) Basic Abdomen, 2) Echocardiography and 3) Advanced Abdomen / Soft Tissue / Small Parts. Participants will be required to submit a casebook of 15 cases. A standardized format of case description, imaging protocol, follow-up verification, case discussion with extensive use of references will be followed. After completion of all short course training and acceptance of their casebook, the participant will take an online written final exam, involving practical case material, and a practical exam to be taken at the annual meeting.

No outside consultation or advice is acceptable. We require IVUSS certification candidates to interpret their own studies when submitting their cases.  An IVUSS certificate holder is able to perform their own scans, interpret them using proper terminology, and make correct recommendations.  Knowing one’s limitations and seeking outside help when warranted is highly respected, but any case requiring this should not be part of the casebook for the certification process.   The same policy applies to use of forums such as Sonopath, Veterinary Information Network, or the like.

Program Overview

Prerequisites:

  • DVM, VMD, or equivalent degree.
  • Member in good standing of IVUSS for the duration of the program.
  • At least 3 years of documentable ultrasound experience in veterinary practice with a minimum average caseload of > 20 cases/month.
  • Active state/national licensure to practice veterinary medicine
  • Ultrasound system in the practice
    • 5.0 to 7.5 MHz small footprint transducer minimum
    • Linear Probe (optional)
    • Phased Array Probe with CF,PW,CW Doppler capabilities
    • B- and M-mode
  • Three didactic and laboratory courses must be completed prior to acceptance into the program. These courses are not provided by IVUSS but must be completed independently.
    • Basic Abdomen
    • Advanced Echocardiography covering CF PW and CW Doppler, with proper adjustment capacity, interpretation and clear understanding/working knowledge of the concepts.
    • Advanced Abdominal/Soft Tissue/Small Parts
    • Didactic training occurs with the following in the United States: Sound, Universal Ultrasound, Oquendo at WVC (for abdomens), and Sonopath.
    • In Europe and Asia: The European School for Advanced Veterinary Studies (ESAVS).  There are numerous other courses at other organizations, these are the most commonly attended by certification candidates. It would be ideal to check with the IVUSS Certification Committee if you are about to take courses from institutions that are not listed here.

Basic Abdomen

    • Instructor
      • ACVR diplomate
      • Or other expert as evidenced by both:
        • publication record
        • acknowledged teaching and technical expertise
    • Didactic Content must include:
      • Principles of Ultrasound
        • Beam formation
        • Resolution
      • Interaction with tissues
      • Transducer types
      • Artifacts
        • Types
        • Principles of formation
        • Means of avoidance
        • Clinical diagnostic value
      • Scanning nomenclature
        • Nomenclature of transducer movements
        • Scan planes
        • Patient scanning methodology
      • Organ Systems
        • Liver & Gall Bladder
        • Spleen
        • Kidneys & Urinary Bladder
        • Genital Tract
          • Female tract: ovaries, uterus
          • Male tract: prostate, testicles
  • Topics for each organ
    • Location
    • How to image
    • Normal appearance
    • Appearance of disease
    • Case discussion
  • Biopsy
    • Basic principles
    • Indications & contraindications
  • Laboratory Content (times provided are an approximate minimum per person)
    • General scanning technique (15 minutes)
    • Nomenclature of transducer movements
    • Scan planes
    • Organ Systems
      • Liver & Gall Bladder (30 minutes)
        • How to image
        • Normal appearance
      • Kidneys & Urinary Bladder (30 minutes)
        • How to image
        • Normal appearance

Echocardiography

  • Instructor
    • ACVIM diplomate (Internal Medicine or Cardiology)
    • Or other expert as evidenced by both:
      • publication record
      • acknowledged teaching and technical expertise
  • Didactic Content must include:
    • Scanning Nomenclature
    • Scan planes
    • Patient scanning methodology
    • M-mode quantification
    • Cardiac nomenclature
    • Cursor placement
    • Leading edge methodology
    • CF/PW/CW Doppler instruction
    • Velocity Measurement
    • Pressure Gradients
    • Interpretation of abnormalities
      • Determination of Diastolic Dysfunction
      • Congenital diseases
        • Pressure overload
        • Volume overload
      • Acquired diseases
        • Primary myocardial
        • Primary valvular
        • Secondary myocardial
        • Cor pulmonale
        • Neoplasia
        • Pericardial Disease
        • Case studies
  • Laboratory Content
    • Content (times provided are an approximate minimum per person)
    • General scanning technique (30 minutes)
      • Nomenclature of transducer movements
      • Scan planes
      • Left apical
      • Left parasternal long axis and modified long axis
    • Structure identification
    • Measurement techniques (45 minutes)
      • RV/LV view
      • Mitral valve view
      • LA/Ao view

Advanced Abdomen/Soft Tissue

    • Instructor
      • ACVR diplomate
      • Or other expert as evidenced by both:
        • publication record
        • acknowledged teaching and technical expertise
    • Didactic Content must include:
      • Advanced Principles of Ultrasound
        • Digital versus Analog beam formers
        • Doppler
        • Advanced beam steering
        • Contrast
      • Organ Systems
          • Abdominal Vasculature
          • Abdominal Lymph Nodes
          • Pancreas
          • Adrenals
          • Gastrointestinal Tract
          • Stomach, duodenum, ileocolic junction
          • Sublumbar region
  • Lymph nodes, colon, vertebra
        • Neck
          • Thyroid, parathyroid & salivary glands
        • Musculoskeletal
        • Thorax
        • Topics for each organ system
          • Location
          • How to image
          • Normal appearance
          • Appearance of disease
          • Case discussion
          • Advanced Biopsy
    • Laboratory Content (times provided are an approximate minimum per person)
      • General scanning technique (15 minutes)
      • Nomenclature of transducer movements
      • Scan planes
      • Organ Systems
        • How to image
        • Normal appearance
        • Pancreas (20 minutes)
        • Adrenals (15 minutes)
        • Gastrointestinal tract (20 minutes)
        • Sublumbar region (5 minutes)

 

  • Alternative methods of covering the didactic material will be considered, including on-line.
  • All laboratory topics must be hands-on with designated instructor

Program Time Frame:

Up to 3 years from time of enrollment to successful completion of the online examination (average time to completion is 2 years). If the time frame is exceeded, an extension must be applied for and an additional fee will be required.

During the 3-year time frame, the candidate must:

  • Complete the casebook of 15 cases
  • Pass a written exam
  • Pass the practical exam at the next annual meeting, which may extend past the 3 year time frame.

Cost:

The cost of the program is split into 3 parts:

  • Initial setup and first 5 cases–$575
  • The next 5 cases–$500
  • The last 5 cases, final written exam and practical exam–$500
  • There may also be a submissions allowance applied: $100 per case for reviewers’ time if there are rejected cases
  • Certification Program enrollees are expected to become a member of IVUSS, a $95 annual cost with great benefits.

Final Examination:

  • After completion of all coursework and acceptance of the casebook of 15 cases, the candidate may take the final examination online.  Exam content will match the listed course content and will be image-based. The examination will be divided into the following sections:
    • ultrasound equipment and physics
    • echocardiography
    • basic abdomen
    • advanced abdomen
  • Each candidate must obtain a 70% satisfactory rating in each of the 4 sections of the examination.
  • After passing the written exam, the candidate is invited to be present for the practical exam at the annual meeting, during the wet lab.
  • Participants may re-take the written examination 30 days after the last unsuccessful attempt.  After three unacceptable examination efforts, the participant will be discontinued from the program with no financial reimbursement.
  • Discontinued participants, due to failure in three attempts at completion of the examination, will need to complete all coursework and casebook submissions again prior to re-enrollment.

Honour system:
No outside consultation or advice is acceptable.  Any evidence of outside consultation or advice on casebook cases or examination material will result in permanent discontinuation from the program.

Casebook Guidelines

Each case submitted for the casebook should list the following:

1) Candidate’s name
2) Patient’s name
3) Case #, Category (eg. case #3, basic abdomen)
4) Date of original submission

The format for each case should reflect how you perform an exam. Date of exam, name of patient and facility should be on all images.

Each case should be presented as a scientific paper suitable for publication in any veterinary journal, with all images of your exam to reflect your thoroughness, your interpretation to reflect your knowledge and ability to communicate your findings and thought processes, and all supported with appropriate references. If the case presentation looks more like the patient’s record than a scientific article, it will not be accepted.

Evaluation of casebooks are scrupulously based on criteria represented here. If that criteria is not followed, the casebooks will not be accepted. That said, if an image of a certain small part (lymph node, adrenal, pancreas, vessel, duct, ureter, etc) is not obtained, the region should be scanned carefully with a captured image representing that region, with an explanation of the process/search.

A casebook of 15 clinical cases will be prepared by each participant.
5 Cases for each topic covered in short the course requirements of:

1) basic abdomen
2) advanced abdomen/soft tissue/small parts
3) echocardiography
One “normal” case will be accepted for basic abdomen and echocardiography.

Click here for an Abdominal Casebook Example

Click here for an Echocardiography Casebook Example

  • Basic Abdomen:
    • One normal exam accepted.
    • Each case needs to include complete set of quality labeled images to include at least one image of each abdominal organ including iliac lymph nodes. Pathological organs should be represented more thoroughly.
    • Choose cases with pathology in one of the following organs: liver, gall bladder, spleen, kidneys, urinary bladder. Variety within the casebook is ideal, i.e. do not submit 4 different liver cases.
    • Examples include masses, urolithiasis, inflammatory changes, etc.
    • Choose cases that will have objective proof of your findings: surgical confirmation, histopathology or cytology, or necropsy reported.
  • Advanced abdomen/soft tissue:
    • Each case needs to include complete set of quality labeled images to include at least one image of each abdominal organ including iliac lymph nodes. Pathological organs should be represented more thoroughly.
    • Appropriate cases will have pathology in any of the following organs: adrenal glands, reproductive organs, common bile duct, pancreas, gastrointestinal tract, vascular, lymphatic, other small parts, non-cardiac intrathoracic pathology.
    • Choose cases that will have objective proof of your findings: surgical confirmation, histopathology or cytology, or necropsy reported. For the rare case in which confirmation was not possible, the differentials for the pathology imaged should be minimal such as an invasive adrenal tumor. Exhaustive differentials without definitive cytology or histopathology will be discouraged.
    • Demonstration of your knowledge and use of power and color Doppler, complex documentations such as portal hypertension, biopsy needle placement, shunt examinations will be highly regarded. 
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  • Cardiac:
    • One normal accepted.
    • Include at least one feline and one canine echo.
    • Complete image set will include B mode images: right parasternal long axis four chamber, right parasternal long axis “five chamber” (LVOT), right parasternal short axis high base, LA/Ao, Mitral, and LV views, at least one, ideally 4-5 views from the apical and/or left parasternal view. M-Mode images will show measurements to include LA, Ao, LA/Ao, and standard LV measurements of wall thickness and chamber size, and calculated fractional shortening. Optional, yet where appropriate, demonstrate knowledge and use of EPSS, and left and right auricular views.
    • Spectral Doppler in canine should include the LVOT/aortic, RVOT/pulmonic, mitral and tricuspid flows, as well as an example of at least one color flow examination with explanations for each case submitted. If aliasing is present on PW then CW should be employed to quantify the lesion. Optional, yet where appropriate, demonstrate knowledge and use of insufficiencies, pressure gradients, transmitral flow, IVRT, pulmonary venous flow, etc.
  • The format for cases must reflect how you perform an exam. Date of exam, as well as name of patient and facility should be on all images.
  • Sonographic description section should provide a radiology based description of the sonographic presentation without differentials. Use of references is appropriate here as well as in the differentials section.
  • The discussion section of the case presentation should be the most extensive portion. It should reflect thorough research and use of references to support the sonographic findings, differentials, and case conclusion and discussion. All references should be cited in the text and no more than 50% of the references should be from textbooks. The remainder should be derived from published articles. A minimum of 5 references for each case should be utilized, but more are encouraged. The relevance of each cited reference in regards to the case presentation should be explained clearly in the case study text.
  • The case study description should justify each procedure performed and if a procedure was not performed that would have been indicated, the candidate should explain why the procedure was omitted
  • The case study should be written based largely on published data and minimally based on personal bias or experience.

  • It is recommended that cases can be submitted individually to program organizers online. The feedback received for each case will help to streamline and improve the process of case submission, as well as improve the candidate’s acumen as a sonographer and clinician.
  • No outside consultation or advice is acceptable. Any evidence of outside consultation or advice will result in irreversible discontinuation from the program.
  • Cases will be evaluated individually.
  • Cases will be evaluated on all image and clinical aspects (see casebook criteria).
  • Participants may re-submit the same case with additional materials, as appropriate.
  • After submission of 10 unacceptable cases, the participant will be discontinued from the program with no financial reimbursement.
  • Discontinued participants will need to complete all coursework again prior to re-enrollment.

Case Final Submission and Acceptance:

Once all requested revisions are made, the Certification Committee gives their approval for that case.  The case report will then receive a final review, comments, and suggestions for improvement by either a board certified radiologist, a board certified cardiologist, or the IVUSS President.  This way, input is offered from multiple sources to improve the sonographer’s clinical ability.

Suggestions to make the process easier for you and help ensure success:

Once the initial payment is made, your IVUSS mentors are assigned, and further instructions for how to submit your cases are given to you by the Certification Committee, you may submit your first case using the sample case format.

  •      Please follow case requirements and format carefully!  We encourage you to email your mentor with questions about the program.  You should expect there to be many comments and suggestions for scanning improvement from the Certification Committee’s reviews on your first few cases.
  •      Choose straight forward cases, especially for your first one.  It will make your learning process more efficient.
  •      Choose a variety of different cases to force yourself to learn more!
  •      Set your goal to submit one case every month, and do it!  Submit your first case within the first month.
  •      You will likely be requested to revise your discussion section to improve your level of knowledge!  Questions will be asked of you that you will need to answer to ensure you meet the high knowledge standards of the program.
  •      It is strongly suggested you complete one case before submitting additional cases to learn how to be more efficient in your case report write-ups.  This way you will be able to be more complete in subsequent cases.
  •      We recommend that you complete at least one echocardiogram, one advanced abdomen, and one basic abdomen case within the first five case submissions.
  •      Perseverance through the program will vastly improve your knowledge and scanning ability.  We want to see you succeed!
  •      REMEMBER—IF THIS WAS EASY, ANYBODY COULD DO IT!