FAQ

[WEBINAR] Use POCUS to Assess Left Ventricular Function in 30 seconds

You need quick answers about cardiac function in your patient presenting with chest pain, dyspnea, or unstable vitals. How can cardiac POCUS help? Dr. Tom Cook, emergency physician ultrasound educator and co-founder of the 3rd Rock Ultrasound, shared his insights in a recent webinar: Cardiac POCUS Part 1: Techniques for Assessing Left Ventricular Function. Watch the full webinar or read on to learn four very simple ultrasound techniques to quickly evaluate the left ventricle and determine the next steps in the management of your patient.

Common Scenario in an ER

An older patient presents to the ER with abdominal pain and a history of rectal bleeding. And by the way, his doctor mentioned that he has heart failure. Vitals indicate he’s in shock – tachycardic and hypotensive, and he has low hemoglobin. He needs volume resuscitation with blood, but with his lingering story of heart failure, the big question is “can this guy’s heart take it?”

A quick focused echo only takes a few minutes, and Dr. Cook demonstrates four techniques to both qualitatively and quantitatively assess this patient’s left ventricular function and determine the next best steps.

  • Myocardial Thickening
  • E-Point Septal Separation
  • Fractional Shortening
  • MAPSE

Myocardial Thickening

The heart muscle is like other muscles in the body. Normal muscle does two things – it gets shorter and thicker with each contraction. This can be easily assessed from the parasternal and apical windows, and there are no measurements needed.

This video shows a nice comparison of normal and abnormal myocardial thickening.

E Point Septal Separation

The anterior mitral valve leaflet is large and anterior, making it easy to see with ultrasound. The excursion of the leaflet can be a very useful tool in evaluating LV function. In a heart with normal LV function, when the valve opens in diastole, the anterior leaflet comes near to or even touches the interventricular septum.

How can this be used to assess function? In a normal heart, the pressure in the left ventricle is very high at the end of diastole because it’s filled with blood. After systolic contraction, when most of the blood has been pumped out through the aortic valve (normal ejection fraction of 60%), the relative pressure in the left ventricle is low. In a normal heart at the end of systole, we know the left ventricular pressure is relatively low. That sets up a big pressure gradient between the atrium and the ventricle, and that allows a large quantity of blood to move from the left atrium into the left ventricle. In early diastole, the mitral valve opens all the way for this to happen. Therefore, if the mitral valve opens completely, the ejection fraction will be high.

In the failing heart, pressure gradient between the left ventricle and atrium, which means there’s a smaller amount of blood moving across the mitral valve, and the valve will not open fully. This indicates a low ejection fraction.

This can be quantified in a measurement called E-point septal separation, or EPSS. Dr. Cook describes the measurement and how it’s done using an m-mode with the m-line placed across the tips of the mitral leaflets. Watch this video to see Dr. Cook’s demonstration on an EPSS measurement using the Clarius PA HD3 handheld ultrasound scanner.

LV function can be estimated based on the EPSS measurement, or the Clarius app will display an ejection fraction on the image screen

Note that conditions like atrial fibrillation, septal hypertrophy, and wall motion abnormalities can limit the accuracy of the EPSS measurement.

Axial Contraction/ Fractional Shortening

The third tool to assess how well the left ventricle is contracting is to look at axial contraction. This is done by imaging perpendicular to the long axis of the ventricle from the parasternal window. During contraction, the muscle in a normal heart gets much thicker and the LV diameter or distance in the axial plane shortens.

Two measurements and a simple equation are needed to calculate fractional shortening, and the easiest way to do this is using m-mode, with the cursor placed just on the apical side of the mitral leaflet tips. Measure the LV at its largest diameter for diastole, and when it’s the smallest for systole.

Learn how to measure FS in this video

Normal range is 25 – 45%, which is different from the normal range for EF, which is 55 – 65%.

Longitudinal Contraction/MAPSE

When imaging the heart in the long axis (from the apex), it is again evident that during contraction, the muscle thickens, and the chamber gets shorter. The LV apex doesn’t move, and the base of the heart moves toward the apex.

This movement can be quantified using a tool called MASPE, and it only requires one measurement. MAPSE is an acronym for Mitral Annular Plane Systolic Excursion, and is very easy to perform:

  1. Acquire an apical 4 chamber view on the heart,
  2. Place the m-mode cursor over the echogenic lateral mitral valva annulus,
  3. Freeze the m-mode and measure the movement of the annulus.

Dr. Cook shows how to measure MAPSE in this video using the Clarius PA HD3 handheld ultrasound scanner.

Dr. Cook stresses that all these tools are essentially linear measurements to describe a 3D structure, so it’s important to also visually assess the heart, keeping clinical scenario and patient history in mind. During the webinar he provides several great video examples and assessments that include the tools previously discussed.

Circling back to the original scenario of a patient who needed volume resuscitation but was in shock and hypotensive: he needed a quick bedside assessment of his heart prior to being given blood products. Two of the four tools discussed here indicate abnormal LV systolic function, therefore fluid resuscitation would likely cause volume overload and pulmonary edema. Based on these results, the treatment plan needed to be altered dramatically.

As with anything in life, you’ll get better with practice. You simply look at these hearts and start running those four tools through your head, and before you know it, you become quite a bit better at judging left ventricular function.”

About Dr. Tom Cook

Dr. Tom Cook is founder of 3rd Rock Ultrasound, an education company designed to help all healthcare providers integrate ultrasound into their practices. 3rd Rock Ultrasound offers a variety of accredited ultrasound courses throughout the year to empower emergency and critical care physicians with the ability to utilize POCUS to improve patient care.

Get Answers Quickly in the ER with Clarius Handheld Ultrasound

Thanks to miniaturization and innovation with handheld ultrasound, you can now carry a high-definition ultrasound scanner in your pocket. To learn more about the high frequency Clarius PA HD3 handheld ultrasound scanner that Dr. Cook uses, visit our emergency medicine page where you be able to access webinars, see customer reviews and watch classroom videos. Feel free contact us today or request a virtual ultrasound demonstration at your convenience.

How Does Clarius Handheld Ultrasound Compare? “The linear scanner is on par with compact systems, no question.”

Dr. Don Buford, a board-certified orthopaedic surgeon specializing in sports medicine and regenerative medicine, was an early adopter of Clarius wireless ultrasound in 2017 and now uses the Clarius C3 HD3 and Clarius L7 HD3 at his practice in Texas. He runs one of the longest-running private MSK ultrasound and Regenerative Medicine courses, offering ultrasound scanning training for everyday clinical practices over two days.

We recently caught up with Dr. Buford over Zoom to talk about how Clarius technology has advanced dramatically from the first to third generations and his passion for advancing the use of ultrasound guidance among his colleagues.

What impresses you about the third-generation Clarius?

The biggest difference I’ve seen is the change in form factor. Your team has nailed it in terms of weight and size. The software has continued to improve and really puts to shame what’s available on some of the other laptop machines. And the image quality is fantastic. The linear scanner is on par with compact systems, no question.

Clarius is lowering the barrier to using ultrasound. I’m amazed by how intuitive it is to use. You don’t have to memorize buttons. Most doctors don’t need to do much more than zoom in and out, turn the gain up and down, and measure the length of anatomy every once in a while.

The Clarius Cloud is a nice way to organize things. Clarius can go to PACS too like other ultrasound systems. But with Clarius Cloud, I put in a couple of keywords or I can annotate exams, which allows me to pull up a group of videos that are all on the same topic, for example. I can also use the Cloud at home. It’s pretty flexible and seamless once you set it up.

Working without wires is slick. It’s easy to keep the transducer clean and you don’t have to worry about infections from cords draping across the patient.”

When do you use Clarius in your practice?

I use Clarius any time I go to the OR. I’m doing a lot of regenerative medicine and I use it for all of my bone marrow aspirations. I generally take the curvilinear scanner to the OR for hip procedures.

I also have Clarius in one of my three exam rooms to guide injections. I have older cart-based systems in the other rooms. One of the unique benefits of using Clarius is that it automatically transfers images and videos to the Clarius Cloud. Once the images are saved, it’s really easy for me to retrieve images for teaching or reviewing. I just go to the Cloud and can quickly find examples of an ultrasound-guided PRP injection for tennis elbow or an ultrasound-guided bone marrow concentration injection for knee osteoarthritis for example.”

Are the benefits of ultrasound guidance still a hard sell for orthopaedic clinicians?

I would say that almost everyone gets it at this point. The problem has moved from “does ultrasound make sense?” to “how do I structure my practice to do it.” The cost factor has gone away because now you can get a high-quality system like Clarius for under 5000 USD. Plus, we do still get paid for using ultrasound for diagnosis or guiding procedures.

It now comes down to training and workflow. I think one clinical approach is that whoever is making the ultimate clinical decision is the one doing the diagnostic exam or the ultrasound-guided injection. That’s the way I’ve always run my practice. But some orthopaedic surgeons rely on PAs to do injections in their office, because they feel their time is better served seeing the next patient or doing something else. I know that works well in many clinics.

We’ve trained a lot of PAs over the years – our course is now probably 40% PA and 40% doctor. In some clinics, both the surgeons and the PAs are trained. With their knowledge of anatomy, surgeons pick up ultrasound quickly. PAs in surgical practices are also quick to learn. With the growing evidence for using regenerative medicine in orthopaedics, there is a growing need for clinicians skilled with ultrasound.”

Is ROI on the ultrasound equipment a factor?

Investing in Clarius is a no-brainer because the payoff for Clarius is fast. You’re paying under 5000 USD compared to laptop machines with comparable image quality that are in the 25,000 to 35,000 USD range.

I crunch the numbers every six months for our course. The average current reimbursement for MSK ultrasound, for diagnostic and ultrasound-guided procedures, is about 80 USD. So even if you do just use it once per clinic day, you’ll pay off the system in less than three months.

Some practices are concerned they’ll lose revenue during the training phase, but most people ramp up quickly and then using ultrasound becomes an additional source of revenue. Most start with ultrasound-guided procedures and then become more and more adept at using ultrasound for diagnosis too.”

Would you recommend Clarius to an orthopaedic surgeon who is not using ultrasound today?

Yes, for a physician who has a sports medicine, orthopaedic, or physiatry practice. It’s an advanced device at an entry-level price, and that’s rare. Traditionally there’s been a direct correlation between the money you spend and the image quality you get on laptop machines ranging from 28,000 to 60,000+ USD. Now, with Clarius, for about 5,000 USD all in, you’ll get a device with the image quality you need that will carry you all the way through your orthopaedic career until you want to do more advanced diagnostics and procedures.”

Could you tell us more about your MSK Ultrasound Training Program?

We hold our course twice a year. It’s a hands-on training program with a cap on attendance at 75 to maximize the learning experience. We have 35 ultrasound machines and 35 models so it generally works out to 2 people per machine, which provides an in-depth experience for participants. Nobody leaves our course not being able to do something they want to do or not being able to see something they want to see!

During the first day, we focus on regenerative medicine and we cover practice management. The second day is the upper extremity, including the shoulder, elbow, hand, and wrist. And then a little more on practice management, like the financial return we’ve talked about. And then we break for lunch. The entire afternoon from about 1 pm to 5 pm is all hands-on and includes live demos.

On the last day, we cover the lower extremity, including the spine, pelvis, and hips. In terms of the pelvis and spine, we’ll cover facet joints, caudal epidurals, SI joints, and piriformis. We also cover knee, foot, and ankle. And it’s a similar format to Friday, where we break for lunch, and then we do our hands-on and live demos. We have also had a great response to our shockwave stations where participants get to learn the science and clinical applications…and then actually use the machines on real patients.”

You’ll find details of Dr. Buford’s upcoming course at https://orthosono.com/.

6 Reasons to Choose Clarius Wireless Ultrasound Over a Compact System for Guiding Safe, Effective Procedures

Here are six key advantages to selecting a Clarius high-definition handheld for your practice:

  1. Improve patient safety with superior MSK imaging
  2. Save time and streamline workflows with AI
  3. Protect your sterile field with wireless ultrasound
  4. Save space and improve patient engagement
  5. Keep records on the Cloud or DICOM
  6. Save up to 85% over compacts

Visit our compare page to learn more about these advantages for your orthopaedic, pain management, or anesthesiology practice.

About Clarius Wireless Ultrasound for Orthopaedic Medicine

Diagnose injuries with confidence and ensure procedural safety, both in the office and on the field, with Clarius wireless ultrasound in hand for instant high-definition MSK imaging. Visit our Orthopaedic Specialty page to learn about the scanners available for your practice. Or book a virtual demo with a Clarius expert in your area.

[WEBINAR] Learn How to Perform Ultrasound-Guided Brachial Plexus Blocks

There is increasing evidence in the literature that states ultrasound guidance is becoming the standard of care for regional anesthesia, and contributes to better, safer outcomes for patients. Regional anesthesiologist Dr. Greg Hickman from the Andrews Institute Ambulatory Surgery Center in Florida has twenty years of first-hand experience using ultrasound for better patient outcomes. He joined us for another instructional webinar, « Ultrasound-Guided Brachial Plexus Blocks: Techniques from the Expert! ». We invite you to watch the full webinar to improve your handheld ultrasound skills and perfect guided blocks for upper extremity surgery or read on for highlights from Dr. Hickman’s presentation.

Early in the webinar, we conducted a poll asking viewers their thoughts regarding performing blocks blindly, and it’s evident that inaccurate, imprecise injections as well as complications are the top concerns.

Dr. Hickman discusses and demonstrates 3 upper extremity blocks for surgeries below the shoulder, using dual guidance with ultrasound and a nerve stimulator.

The Supraclavicular Brachial Plexus Block

Dr. Hickman calls this block the “Spinal of the Arm”. It’s his “go-to” block at the Andrews Institute as it proves rapid and highly effective analgesia for all upper extremity surgeries. This block happens at the level of the divisions of the trunks

Anatomical landmarks are the clavicle and the sternocleidomastoid. On the ultrasound, landmarks are the subclavian artery and the 1st rib.

“Find the group of grapes just posterolateral to the subclavian artery, and that’s our go-to”.

Watch this Clarius Classroom video to see how Dr. positions his patient and the ultrasound scanner, locates the supraclavicular brachial plexus, and performs the block with a total of 30 cc’s of analgesia injected to surround the trunks.

The Infraclavicular Brachial Plexus Block

This block is at the level of the lateral, medial and posterior cords, and like the supraclavicular block, is predictable, has fast onset, and is effective for the whole arm and hand. During the webinar, Dr. Hickman explains why this is his preferred block when using a continuous catheter.

With the scanner in long axis, and placed in the deltopectoral groove, anatomical landmarks include the inferior aspect of the clavicle and medial to the coracoid process. Locate the axillary artery to identify the cords of the plexus.

Dr. Hickman uses a retroclavicular approach for this injection because there’s no special patient positioning, and he can visualize his needle in-plane, at an optimal angle, as it appears from beneath the clavicle.

Slight needle manipulation under ultrasound guidance ensures anesthetic deposit around each cord.

Watch the video:

The Axillary Brachial Plexus Block

In cases where a supra- or infraclavicular block is technically challenging, the axillary block can be very effective and easier to perform because of the superficial nature of the plexus. The radial, ulnar, median, and musculocutaneous nerves can be easily identified with ultrasound, and the needle is highly visible with the angle of approach Dr. Hickman uses, making the injection accurate and effective.

The key ultrasound landmark for this block is the axillary artery, imaged in short axis. The radial, ulnar and median nerves lie in close proximity to this prominent vessel, and the musculocutaneous nerve can be seen close by in the intermuscular septum between the biceps brachii and brachialis muscles.

Watch this live video to see the median and ulnar part of this block.

Dr. Hickman has been using ultrasound to guide his blocks for 15 years now.

I didn’t realize the true impact of how much it was going to change and how many more people would get into regional anesthesia because so many people can feel more comfortable with this than trying to do those blind techniques,” he says.

For more detailed instruction and full brachial plexus block demonstrations watch the full webinar, « Ultrasound-Guided Brachial Plexus Blocks: Techniques from the Expert! ». Visit the Clarius Classroom for these and other regional anesthesia block procedures.

Dr. Hickman is co-founder of the popular ultrasound-guided regional anesthesia education website Blockjocks.com, which teaches doctors, nurses, and patients around the world. He uses the Clarius L15 HD3 at his practice.

About Clarius for Regional Anesthesia

The miniaturization and innovation of handheld ultrasound mean high-definition imaging is now easy and affordable, offering savings of up to 80% on the cost of a traditional ultrasound system. Clarius offers three wireless handheld ultrasound scanners that are suitable for safe regional nerve blocks and post-operative follow-up. For more information, visit our anesthesia specialty page. Or contact us today to request a private virtual demonstration of the ultimate wireless ultrasound scanner.

[WEBINAR] Practical Small Animal Ultrasound: How to Scan the Canine Urinary Bladder

The use of ultrasound in small animal veterinary practices has become an essential imaging tool. Miniaturization, improved resolution, and lower cost of ultrasound systems along with specialized vet scanners and presets enable veterinarians to easily image the bladder in their furry patients who present with urinary symptoms.

We recently partnered with Dr. Camilla Edwards of First Opinion Veterinary Ultrasound to present a webinar, « Practical Small Animal Ultrasound Kidney and Urinary Bladder Point-of-Care Scanning Techniques », dedicated to ultrasound techniques for canine kidneys and bladder. Camilla is a peripatetic veterinary sonographer who teaches ultrasound with IMV-imaging, Celtic SMR and delivers her own courses. She uses ultrasound extensively in her practice and believes that everyone in her profession deserves to have the skills and confidence to use veterinary ultrasound to help improve diagnosis.

Watch the full webinar to learn:

  • Indications for bladder ultrasound
  • How to find the bladder using ultrasound
  • Scanning tips to ensure a thorough exam
  • Pathology

Webinar Highlights

If you don’t have time to watch the webinar, here are some quick tips and a video excerpt on how to scan a canine urinary bladder.

According to Dr. Edwards, indications for scanning the urinary bladder include changes in urination, pyuria, hematuria, proteinuria, and unresolved cystitis. A distended bladder is helpful when evaluating the bladder wall for thickness or masses, and the lumen for sediment or uroliths.

Technique for Scanning the Bladder (Left lateral recumbency if the right kidney was just scanned)

  • Caudal abdomen – look from ventral towards dorsal
  • Fan through bladder left and right
  • Rotate 90 degrees – fan cranial to caudal
  • Dependent view (through the bladder towards the table)

Watch this video to see Dr. Edwards using the Clarius C7 HD3 Vet to scan a canine bladder.

During the webinar, Dr. Edwards shares an example of a dog named Chewy who presents with hematuria. Watch the full webinar for more information about how using ultrasound helped determine the next steps in treatment.

Visit Dr. Edwards’ website for more information about the educational services she provides, or get in touch at camilla@fovu.co.us .

Clarius Wireless Ultrasound for Veterinary Practice

Dr. Edwards uses the C7HD3Vet in her small animal practice. To learn more about how wireless ultrasound can benefit your practice, please visit our Veterinary Specialty Page. You can also access additional veterinary webinars and classroom videos on our website.

To see a personal demonstration of our new smaller and lighter Clarius HD3 Vet scanners contact us today or request a virtual ultrasound demo.

[VIDEO] Why Dr. MJ Rowland-Warmann Says the New Clarius Power Fan is “Simply Brilliant!”

Medical aesthetics expert and educator Dr. MJ Rowland-Warmann was one of the first to use the new revolutionary Clarius Power Fan HD3, which provides unlimited power and cooling around the clock.

Especially for long and complicated procedures, the addition of the Power Fan has been absolutely invaluable. Patients are safer, practitioners are happier, and we can deliver exceptional predictability and safety in our procedures to get better outcomes. It’s simply brilliant,” says Dr. MJ, founder of Smileworks Hub.

Dr. MJ recently used her Clarius L20 HD3 scanner during a day-long aesthetic training session: “No longer do I worry about the scanner running out of battery or overheating. We can use the Clarius endlessly if we need to. During hands-on ultrasound training, it has been an absolute godsend.”

Watch the Clarius Power Fan HD3 in action in this one-minute video recorded at an aesthetics training session with Dr. MJ.

Clarius Power Fan HD3 is Available Now

Available now for new and existing users, the Clarius Power Fan HD3 enables all-day scanning with any of our ten HD3 portable ultrasound scanners. While other handheld ultrasound systems typically start running hot after 20 to 30 minutes, with this new accessory, clinicians can use Clarius handheld scanners without interruption 24/7. It provides continuous power supply and cooling, which is a first for handheld ultrasound systems. For long scanning sessions, clinicians can snap on the Power Fan to keep their scanner cool and plug the Power Fan into a portable battery pack or outlet to keep the scanner running as long as needed.

Current and new users of Clarius HD3 scanners in 90 countries can purchase the Clarius Power Fan HD3 for 159 USD in the United States, 210 CDN in Canada, 159 EUR in Europe, 134 GBP in the United Kingdom, and 234 AUD in Australia.

Book a Demo Today! 

We would be delighted to show you the world’s best handheld ultrasound scanner, now with continuous power and cooling. Please contact us for pricing and availability or to schedule a virtual demonstration with a Clarius expert in your region.

[VIDEO] A Handheld Ultrasound First: Scan Forever with the New Clarius Power Fan HD3

Once considered an impossible task for handheld ultrasound scanners, Clarius has cracked the code for all-day scanning with our new Clarius Power Fan HD3, which provides unlimited power and cooling around the clock.

This revolutionary new accessory, available now for new and existing users, enables all-day scanning with any of our ten third-generation portable ultrasound scanners. It provides continuous cooling and power supply, enabling clinicians to scan without interruption, which is a first for handheld ultrasound systems.

Until now, having to recharge batteries and cool handheld ultrasound systems between scanning sessions has been required for every handheld ultrasound device. We’re excited to conquer this common industry challenge with the Clarius Power Fan HD3,” says Kris Dickie, Vice President of Research and Development at Clarius. “With image quality and performance that now rivals compact ultrasound systems, clinicians are using Clarius handheld scanners for a range of applications beyond point-of-care exams, including for longer, more comprehensive examinations and education purposes. The ability to provide unlimited scanning is an exciting breakthrough for using handhelds in every setting.”

Other handheld ultrasound systems typically start running hot after 20 to 30 minutes and can run on battery power for 1 to 2 hours with recharge times ranging from 75 minutes up to five hours for fully recharged batteries. With the new Power Fan, Clarius HD3 is the only handheld ultrasound system that enables 24/7 ultrasound scanning. Clinicians can snap the Power Fan onto the scanner to keep it cool and plug the Power Fan into a portable battery pack or outlet to keep the scanner running continuously.

During testing, Clarius had scanners running continuously at its headquarters for multiple weeks prior to sending it to users for field trials. Practitioners with early access reviewed the Clarius Power Fan HD3.

“The addition of the Power Fan means we can scan endlessly if needed. Patients are safer, practitioners are happier, and we can deliver exceptional predictability and safety in our procedures to get better outcomes. It’s simply brilliant,” says Smileworks founder Dr. MJ Rowland-Warmann.

Dr. Rowland-Warmann recently used her Clarius L20 HD3 scanner during a day-long aesthetic training session: “It made a huge difference. We didn’t run out of battery and the scanner stayed cool. The addition of the Power Fan makes the best handheld ultrasound system for aesthetics even better!”

Dr. Alberto J. Panero, D.O., board certified in physical medicine and rehabilitation, has been using his Clarius L15 HD3 and the new Power Fan HD3 for guiding pain management injections at his busy sports medicine clinic. “The Power Fan gives me the extended battery I need to make it through back-to-back ultrasound exams or cases that run longer than expected. It is easy to plug and play and puts my mind at ease.” The Clarius Power Fan is available now for current and new users of Clarius HD3 scanners. Contact Clarius for pricing and availability in more than 90 countries worldwide.

Book a Demo Today!

We would be delighted to show you the world’s best handheld ultrasound scanner, now with continuous power and cooling. Please contact us to schedule a virtual demonstration with a Clarius expert in your region.

[WEBINAR] Learn Ultrasound Guidance Techniques for Safer Injections in the Temple and Midface to Avoid Complications

Dr. MJ Rowland-Warmann has been using the Clarius L20 at her practice since 2020. She is the founder and lead clinician at Smileworks Hub in Liverpool. Dr. Rowland-Warmann has a special interest in the management of dermal filler complications using ultrasound and is a huge advocate for safer aesthetic procedures and is working toward raising industry standards.

We recently co-hosted a lively webinar titled « Avoiding Filler Complications Using Ultrasound to Guide Safe Cheek, Temple, and Tear Trough Injections« . Watch the webinar or read on for a quick summary.

Ultrasound is the most important thing to come to aesthetics since the invention of dermal filler,” according to Dr. Rowland-Warmann. Literature citing research continues to support this assertion.

In the webinar, Dr. Rowland-Warmann describes the many benefits of using high-resolution ultrasound before, during and after filler procedures, and shares live video of ultrasound-guided procedures on two patients.

  How Ultrasound Can Help Us

  • Filler treatment – before, during and after
    • Before – identify anatomy and perform vascular mapping, essential for treatment planning and safer injections
    • During – also called guided therapy, ensuring precise and more predictable filler placement
    • After – confirm filler placement and vascular integrity
  • Diagnosis and management of complications
    • Identify occlusions and treat them quickly and effectively
  • Monitor filler over time – identify previously injected filler and manage your patient accordingly
  • Diagnosing filler types – ultrasound appearance can vary with different fillers
  • Learning anatomy – identifying structures under the skin in real-time is invaluable when performing injections

Performing US Guided Temple Augmentation

Although there are six different injection techniques for the temple, Dr. Rowland-Warmann prefers the interfacial technique. Watch the video as she describes the fascial layers of the temple, and the ultrasound appearance of the superficial and deep temporal fasciae. Color Doppler is a valuable tool to identify the superficial and deep temporal arteries in this area between these 2 layers is the deep fat layer, where the filler is placed with precision using ultrasound guidance.

Performing US Guided Cheek Injection

Treatment of the cheeks is considered relatively safe, but Dr. Rowland-Warmann likes to use ultrasound for precision in this area. She states that “guided volumization is predictable”, so she uses ultrasound to place filler into the deep fat compartment for the best results. Watch the video.

Performing US Guided Tear Trough Filler Placement

The tissue around the eye is very thin, so effective injection must occur beneath the orbicularis oculi and just above the periosteum to avoid eye bags. In this video, Dr. Rowland-Warmann shows how to visualize and guide her cannula into this very thin compartment, avoiding the angular vein.

Dr. Rowland-Warmann uses the L20 Ultra-High Frequency Linear Scanner to visualize anatomy prior to filler placement each and every time, to ensure safety and the best results for her patients.

Interested in learning more about Clarius for Aesthetic Procedures?

More aesthetic clinicians like Dr. Rowland-Warmann are using Clarius high-definition wireless ultrasound to ensure safer procedures and better results. Clarius is now more affordable and easier to use than traditional ultrasound systems. The Clarius L20 HD3 is the world’s first high-frequency handheld scanner, with exceptional superficial imaging and specialized for facial aesthetics.

Contact us today or request an ultrasound demo to see how high-definition imaging can help you improve safety and deliver consistent patient outcomes in your practice.

[WEBINAR] Ultrasound Essentials for Breast Plastic Surgery: Visualizing Silent Ruptures, Seromas, and PECS Blocks

Breast implants have evolved and grown in popularity since the first silicone implant was developed by Houston Plastic Surgeons, Thomas Cronin and Frank Gerow. To this day, breast augmentation remains the most common procedure performed worldwide.

While implants are proven to be safe, occult or silent ruptures are not uncommon. In fact, clinical data from a recent study by Dr. Marc Salzman showed that out of 584 women with silicon gel implants in place for 3 to 20 years, 10.6% had an implant rupture they were not aware of.

At his practice in Kentucky, Dr. Salzman uses his Clarius HD3 scanner to assess implant integrity and diagnose pathology associated with augmentation surgery. We recently invited Dr. Salzman to share his ultrasound techniques for plastic surgery during a one-hour free webinar. Watch the webinar or read on for some highlights.

The vast majority of patients (>95%) want to know if their implant is broken and would want it removed, even if they have no symptoms.

High-resolution ultrasound (HRUS) of breast implants can provide an abundance of information and can be easily performed in an office setting as a screening tool for asymptomatic women. Broken saline implants are self-evident, while broken silicone gel implants can have various presentations.

Notable takeaways from this is that in-office ultrasound can certainly be learned by MDs and ancillary providers,” says Dr. Salzman. “Ultrasound may be the first choice for implant surveillance because of the ease of use, it’s in the office; its lower cost, and it’s immediately available in an office setting.”

In this cohort of asymptomatic women with silicone breast implants, the incidence of silent rupture may be as high as 10.6%, so we may start seeing more demand from patients for implant screening with ultrasound.

Screening for Silicone Implant Rupture

Mammography is the least sensitive imaging modality, with 11-69% sensitivity for rupture.

Silicone is very radio-opaque, which makes it difficult to see an intra-capsular rupture.

MRI is considered to be the gold standard for intra-capsular rupture, but it may be cost-prohibitive to many patients, and access may be limited depending on location.

With operator experience, high-resolution Ultrasound sensitivity and specificity are approaching MRI. The difference – wireless ultrasound is inexpensive and available for use in an office setting. In the U.S. the FDA now recognizes screening for silent ruptures with HRUS as an alternative to MRI.

Ultrasound Appearance of Normal Intact Gel Implant vs Saline Implant

Watch this video to see how Dr. Salzman performs a thorough HRUS examination of breast implants.

There are several ultrasound characteristics of broken implants, including:

  • Free gel-snowstrom pattern
  • Stepladder sign
  • Shell fragments
  • Discontinuous shell
  • Keyhole deformity
  • Combinations of each

Watch the full webinar, « Ultrasound Essentials for Breast Plastic Surgery: Visualizing Silent Ruptures, Seromas, and PECS Blocks », for details

In this video, Dr. Salzman identifies an implant rupture and an upside-down implant in his asymptomatic patient.

High-resolution ultrasound for evaluation of the Swollen Breast

  • Post-surgery
    • Seroma versus hematoma
  • Location of fluid
    • Peri prosthetic versus subcutaneous
  • Resolution of hematoma
    • Timing of aspiration

LAP Block (lateral approach pectoralis block) for better results and post-op pain control

Dr. Salzman has customized the traditional ultrasound-guided PECS block using a lateral, in-plane approach. Using video footage from another client, Dr. Salzman demonstrates how to effectively perform a pre-operative pectoralis nerve block with techniques that will drastically reduce post-operative pain and speed post-surgical recovery. You’ll see your clients going out for dinner after their breast surgeries!

See how it’s done in this short video.

Free Upcoming Webinar on Ultrasound Guidance for BBLs

Dr. Pazmiño is presenting a webinar with Clarius on July 14, 2022, to provide free education for plastic surgeons looking to use ultrasound for safer, more accurate BBL procedures. Physicians are invited to register on the Clarius website for the live webinar “Ultrasound Guidance for Safe Brazilian Butt Lifts: Precision BBL Techniques from the Expert.”

Clarius Wireless Ultrasound for Plastic Surgery

Dr. Salzman uses the Clarius L7 HD3 in his plastic surgery practice. Clarius offers three ultrasound scanners that are suitable for plastic surgery procedures. Available for a fraction of the cost of a traditional ultrasound system, and wireless for exceptional portability, they deliver clear high-resolution imaging for breast, safer Brazilian Butt Life Procedures, regional blocks to prevent pain and more.

Contact us to learn more about Clarius wireless ultrasound for Plastic Surgery or schedule a virtual private demo today to learn which Clarius scanner is right for your practice.

[WEBINAR] Practical Small Animal Ultrasound: How to Scan the Canine Kidneys

As ultrasound systems become smaller, more affordable and easier to use, they’re becoming an essential tool to quickly see what’s going on under the fur at small animal veterinary practices.

As part of our program to help new veterinary ultrasound users improve their ultrasound scanning skills, we often partner with Dr. Camilla Edwards of First Opinion Veterinary Ultrasound to produce webinars and video tutorials.

Dr. Edwards recently presented a webinar, « Practical Small Animal Ultrasound Kidney and Urinary Bladder Point-of-Care Scanning Techniques », dedicated to ultrasound techniques for canine kidneys and bladder. 

Watch the full webinar, to learn:

  • Indications for ultrasound of the kidneys
  • Using ultrasound, how to find the left and right
  • Scanning Tips to ensure a thorough exam
  • Case studies with pathology

Or read on for highlights on how to scan the kidneys.

Indications and Techniques for Scanning Small Animal Kidneys

According to Dr. Edwards, there are many indications for scanning the kidneys in small animal practice. Changes in urination, raised blood values, palpable mass and PUO are all great reasons to investigate with ultrasound.

Technique for Scanning the Left Kidney (Right lateral recumbency)

Watch the video to see Dr. Edwards describe the ultrasound appearance of the normal kidneys and signs that may indicate pathology.

  • Follow costal arch from xiphisternum, pass the liver, stomach and spleen
  • Rotate the scanner to find the longest view of the kidney
  • Take measurements 3X and use the longest value
  • Fan through dorsally and ventrally
  • Rotate the scanner 90 degrees and fan through cranially and caudally

Technique for Scanning the Right Kidney (Left lateral recumbency)

In this video, Dr. Edwards demonstrates how to scan the right kidney.

  • Follow costal arch to the lumbar musculature (look further cranially than on left)
  • Rotate the scanner to find the longest view of the kidney
  • Take length measurements 3X, use the longest value
  • Fan through dorsally and ventrally
  • Rotate scanner 90 degrees and fan through cranially and caudally

 Visualizing Kidney Abnormalities with Ultrasound

There are a variety of abnormalities that can be visualized with ultrasound. Pathologies include:

  • Nephrolithiasis
  • Hydronephrosis
  • Renal parenchymal disease
  • Renal Cysts
  • Renal Infarction
  • Renal Neoplasia

Dr. Edwards has recorded two ultrasound videos of patients with renal pathology: a cat named Poppy is possibly in renal failure, and Waffle, a cat with hyperthyroidism.  Watch the full webinar to watch the videos and for more information about how using ultrasound helped determine next steps in treatment.

About Dr. Edwards

Dr. Edwards is a peripatetic veterinary sonographer who teaches ultrasound with IMV-imaging, Celtic SMR and delivers her own courses. She uses ultrasound extensively in her practice and believes that everyone in her profession deserves to have the skills and confidence to use veterinary ultrasound to help improve diagnoses. Visit Dr. Edwards’ website for more information about her and the educational services she provides, or get in touch at camilla@fovu.co.us.

Clarius Wireless Ultrasound for Veterinary Practice

Dr. Edwards uses the C7 HD3 Vet in her small animal practice. To learn more about how wireless ultrasound can benefit your practice, please visit our Veterinary Specialty Page. You can also access additional veterinary webinars and classroom videos on our website.

To see a personal demonstration of our new smaller and lighter Clarius HD3 Vet scanners contact us today or request a virtual ultrasound demo.

[WEBINAR] Using Ultrasound for Safe Injections of the Lower Face: Deep Piriform Space and Jawline 

During a recent webinar, Dr. Steven Weiner, a board-certified head, neck, and facial plastic surgeon also known as the “Jawvinator,” showed us how he uses ultrasound to minimize the risks and complications associated with cosmetic filler injections. Watch his full webinar, « Using Ultrasound for Safer Injections of the Lower Face: Deep Pyriform Space and Jawline« , or read on to learn how Dr. Weiner scans the jawline and deep piriform space to understand each patient’s unique anatomy.

The use of dermal fillers for soft tissue augmentation has become an integral part of aesthetic practices, but even in the hands of experienced clinicians, adverse effects can and do occur.

Poll Indicates Variability of Anatomy is a Common Challenge for Safe Injections

We conducted a webinar poll asking about the challenges attendees are faced with when injecting dermal fillers. Not surprisingly, despite knowledge of anatomy, variability of vascular structures appears to be the most common challenge.

In this recent webinar, we also asked what physicians saw were the key benefits to bringing ultrasound to facial aesthetics. The most common result was reducing the risk of complications with improved safety, followed by the identification of vascular structures, and a rapid, effective response to complications.

Vascular mapping with high-resolution ultrasound has been a game-changer for Dr. Weiner. With the Clarius L20 HD3 scanner, he can easily locate important tiny vascular structures in the face prior to injection and confirm filler placement away from these vessels following injection.

Deep Piriform Space & Angular Artery

The angular artery lies superficial to the space in the majority of people. It typically runs medial to the NLF at 3 mm in depth.

However, there are several anatomic variations including 1 – 3 branches. There can also be variations in the same patient from side to side.

30% of the time, there’s no artery. 1% to 2% of the time, it’s in the exact spot that you want to inject. So how do you know that? Well, you need to use your ultrasound to determine that, » warns Dr. Weiner.

Should We Rely on Aspiration or Ultrasound?

As you can tell by the following illustration, on the right side, it’s possible that you can get a negative aspiration by pinching off the vessel with the needle and still injecting inside the vessel.

Video Demonstration: Piriform Injection

Piriform injection is done straight down and onto the periosteum.

In this video, Dr. Weiner uses ultrasound to locate the angular artery about halfway between the skin and the periosteum. The bolus of hypoechoic HA filler can be seen along the periosteum, and the artery is intact.

You can confirm to the patient that you saw everything, and it gives the patient confidence that the procedure was done safely,” says Dr. Weiner.

Jawline Injections & Facial Artery

The Facial artery is a branch of the external carotid artery. It is the main supplier of blood to the anterior face. The facial artery typically crosses the mandible in the antegonial notch. There can be variations in the location and branching of this vessel as well, so Dr. Weiner recommends confirming its position with ultrasound prior to jawline injections.

Planes of Injections include:

  • Superficial (subcutaneous or supra-platysma) plane in superficial fat
    • Safe – Facial artery is deep
    • Better correction per CC
  • Deep onto the periosteum
    • Less noticeable filler
    • Can’t place deeply in antigonial notch
  • Combination

In the next video, Dr. Weiner marks the location of the artery and vein so he can safely inject posterior to them. Watch the video to see his technique.

5 Ways Ultrasound Can Help Your Practice

  1. Improving patient safety with vascular mapping
  2. Mitigate the risk of filler complications
  3. Solve complications with real-time imaging
  4. Increase patient confidence with high-definition imaging
  5. Increase billings and referrals

Ultrasound is the gold standard for evaluating patients, particularly with filler complications, » he says. « But it’s better to be pre-emptive by evaluating vascular structures using vascular mapping in advance to avoid these structures when you’re doing the injection.”

Watch the full webinar, « Using Ultrasound for Safer Injections of the Lower Face: Deep Pyriform Space and Jawline« , to learn more about piriform and jawline injections.

About Dr. Weiner

Dr. Weiner practices at the Aesthetic Clinique in Florida, a company he began over 15 years ago.

He uses the Clarius L20 HD3 high-frequency scanner, which he considers ideal for facial aesthetic procedures with its ability to provide excellent detail of superficial structures.

Dr. Weiner offers a course called Sonosthetics with courses in Los Angeles, Vancouver, Chicago, New York, Salt Lake, Hickory, and Atlanta.

Improve Patient Safety for Facial Aesthetics with Ultrasound Guidance

Thanks to miniaturization and innovation with handheld ultrasound, high-definition imaging is now easy and affordable, offering savings up to 80% on the cost of a traditional ultrasound system.

To learn more about the high frequency Clarius L20 HD3 handheld ultrasound system that Dr. Weiner uses, and the Clarius 9.0 App with Advanced Plastic Surgery Package, contact us today or request an ultrasound demo.

We would love to show you the difference ultra-high-definition imaging makes for facial aesthetics. Contact us or visit our Aesthetics Specialty Page to learn more.

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