April 18, 2024 • 32 mins
In this episode of The Sonography Lounge, hosts Lori Green and Trisha Reo sit down with Heidi Ehrich, RDMS, RMSKS in this career spotlight episode to talk about her experience getting into ultrasound as a full time musculoskeletal sonographer at the University of Michigan, Michigan Medicine program.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
Recording from the Sunshine CitySt.
Petersburg, FL overlooking beautiful Tampa Bay, this is the
Sonography Lounge. Sponsored by Gulf Coast
Ultrasound Institute. This podcast is dedicated to
medical professionals and patients around the world
interested in diagnostic and interventional ultrasound.
(00:25):
Our podcast will discuss everything ultrasound from news,
trends, career paths, new technology, and industry
updates. Hosted by Lori Green and Tricia
Rio of Gulf Coast Ultrasound Institute, they bring over 4
decades of experience in the ultrasound profession and are
here to guide you through this journey.
Now sit back, relax and enjoy. Hey, everyone, and thank you for
(00:51):
joining us in the Sonography Lounge where we discuss all
things ultrasound. I'm Tricia Rio, and I'm joined
by my Co host, Lori Green. Hey, everybody.
And today's episode as part of our careers in sonography, we'll
be chatting with Heidi Erik about a day in the life of an
MSK sonographer. Welcome, Heidi.
Hi, thanks for having me. Yes, thank you for joining us.
(01:13):
Yeah, absolutely. We're so happy to have Heidi
with us today, and why don't we just get started off by having
you tell us a little bit about how you got started in MSK
Ultrasound. All right.
Well, I have been doing MSK ultrasound for 17 years now at
the University of Michigan. I started there as a general
(01:34):
stenographer and about that timeDoctor Jacobson and some others
were starting to grow ultrasoundin the MSK department.
So they took up a few texts initially to train with them and
then when I was about six years in, I went up to train with the
three original tax and the MSK radiologist did that for about
(01:55):
10 years and decided to give up general and go full time MSK.
We just don't have enough peoplethat know how to do it.
So I was kind of needed a littlebit more consistently.
And then a couple years ago, I also took on the lead
stenographer role in our department and that kind of
brings us up to now. That's fantastic there.
You're all right. There's very few experienced MSK
(02:19):
stenographers. So to have that opportunity to
learn and train, especially withexperts like Doctor Jacobson to
and you know, put that skill into into practice is amazing.
It's a really fantastic opportunity.
Yeah, I mean, I just think abouteverything you have to learn to
become an MSK stenographer. You know, you go into it, if
(02:40):
you're already a stenographer, you already have a really strong
basic knowledge of ultrasound, but then you have to learn all
of that anatomy and Physiology of the musculoskeletal system.
So I'm sure that's plays a role into how it differs.
But can you tell us, just in general, how does being an MSK
stenographer different from being a general stenographer on
your daily basis? Well, yeah, like you said, it's
(03:02):
a it's a whole new set of anatomy pathology.
So that learning that is an enormous undertaking.
And I myself had no previous X-ray experience where you learn
some of these like Bony landmarks and things.
So I had to learn, you know, from scratch.
I didn't know what a tuberosity was or anything.
And those are very important forMSK imaging.
You know, you have to learn all this new anatomy, learn the
(03:23):
pathologies and then the actual technique.
So instead of like doing broad strokes with the curvilinear
probe, looking over these, you know, kind of wider areas like
the liver, we're looking for an Adamine pathology and a very
tiny footprint. So we're looking for very
complex anatomy that can be likein the space of a couple
centimeters. So we have to really train our
(03:44):
eye to slow down and look for really subtle abnormalities.
And you know, just as as different as the anatomy and
pathology is, you know, our approach has to be a little bit
different to to the way that we kind of get in there and
evaluate for things. Yeah.
And would you say it was easier to learn by doing scanning, or
did you find that sitting down and kind of reviewing anatomy
(04:08):
and Physiology from a book helped you more at first?
It really is a, a, a combinationof those things.
So you have to, you have to memorize these things, right.
So all of that didactic book stuff is important because it's
all new terms and all new structures.
And, you know, we, there wasn't really a lot of must be scaled
to ultrasound books back in the early 2000s.
(04:29):
So like the Netter orthopedic anatomy was like our Bible and
we used to like color, do coloring pages just to see where
these tendons went, you know, from the muscle to the bone.
But then yes, obviously, like the hands on.
So sitting with someone who knows what they're looking at
and then, you know, like practicing doing post scanning
and, you know, scanning friends or just whatever it's, you know,
(04:51):
just as a general photographer would do.
But just, you know, it's a wholenother set of anatomy there.
But yeah, the hands on is very important as well.
Yeah. Yeah, absolutely.
It definitely is a different scanning technique compared to
doing abdominal or OBGYN, you know vascular you making those a
little subtler movements when you're scanning, you know
(05:14):
between vessels and so forth. But definitely MSK has its own
little. Well, then you're scanning on
top of bone. So I even, we just had our
blended MSK course these last two days.
We just wrapped up at 12 O clockand I heard one of the
instructors telling the participant who is a
sonographer, it's you have to use your fingers to really plant
(05:35):
yourself, to give yourself something to hold onto because
otherwise you're just going to keep sliding right off of that
bone. And she said that she goes, it's
so different than scanning everything else that I scan
because you do you just slide right off.
Right. Right.
And, you know, the movements aremuch smaller when we, you know,
take on new stenographers to train, you know, they're they,
you just move so fast because you're used to like covering a,
(05:58):
a bigger area. But when we're really talking
about like this tendon is, is 2cm and you have to, there's a
lot of the tendon that you have to look through, even though
it's so small, it's really like the hand movements are very,
very subtle. Otherwise you're gonna come
right off and be all the way outof it.
Yeah. Yeah, very easy to miss things
if you're not scanning slowly. Yeah.
(06:22):
In parallel, we learned that word right, the anisotropy word.
Yeah. Yeah.
So perpendicular, that's a big structure, right?
Yeah. Yeah, that's a big one.
First you have to learn how to say the word.
Yeah. Then you'd have to learn how to
avoid. It's a whole new set of
everything, vocabulary and everything.
(06:45):
That's right. As Tricia was talking to you
about how it's different from being a general stenographer to
an MSK stenographer, how the thedaily activities and your
patient throughput and so forth,I'm sure is a little bit
different than in the general ultrasound department.
So how does what does a day in an MSK stenographers department
(07:08):
look like as far as that goes? Yeah, it is.
It is slightly different. So at my institution at
University of Michigan, we have a very large general department.
We have about 70 stenographers, but we also have a pretty good
MSK department as well. So we have 9 MSK stenographers,
we have 6 full time rooms running between the hospital and
(07:29):
three outpatient centers and then there's another 2 rooms
running run by the P As for ultrasound guided procedures
like general, we would scan and then we in our hospital show our
studies either to a practitioneror a radiologist.
For the MSK, it's the radiologists themselves and
they'll we'll look over things and determine if we need to post
(07:52):
scan for any additional imaging and then we also dictate.
So our MSK technologists have been trained to dictate cases
and that really helps save time for the staff that they can just
kind of edit and sign off as they need.
Occasionally we also will give verbal reports to clinicians if
we have like an in house add on or if the report needs to get to
(08:17):
the doctor and the our staff is not on site or if they're busy
on another service or something.Yeah, I know that that probably
is. You're learning how to perform
ultrasound in musculoskeletal applications.
Learning how to dictate it, I would imagine really helps you
more than it hinders you. Because I, when I learned
(08:39):
vascular, that's how I learned was I had to dictate my own
studies into a phone and call number and dictate it and then
it would be reviewed by the radiologist or vascular surgeon
who was on call. And I found that that really
helped me. So do you guys feel like
dictating your cases as more of a burden or a benefit in your
department? Yeah, it's, it's definitely a
(09:00):
huge benefit. So our MSK taxi, they dictate,
but it's one thing to kind of like scan and figure out, you
know, what's going on to create an imaging story or to explain
it to a radiologist. But you know, it's a whole other
thing to put this in professional verbiage for the
clinician or medical legal documentation.
(09:21):
So you have to be really familiar with the pathologies
and how to describe them in detail.
You also have to be very familiar with the differential
diagnosis that you might need togive.
Sometimes we have to recommend further imaging on something.
So over time you kind of learn what would be the most
appropriate study to best suggest for that.
But you know, at the end of the day, the doctor still has the
(09:43):
the final edit to sign off. So it is, you know, their name
on the report. But we have found that it just
really helps you grow in your learning and understanding that
you're not just taking the picture.
You're able to describe, you know, professionally how to
describe this and, and put it ina report for the, the doctor and
the patient's gonna be reading that later too, so.
(10:04):
Yeah. And it's very similar to what we
do with our worksheets, right? You do your technical
impression, it's just a little bit more.
I don't know. It's more a little more
elaborate because you do. Have to.
You know, generate a a report that you know more it.
Describes. It in more detail and I know I
(10:24):
did the same thing and when I worked with a vascular surgeon
that you know, we wrote a technical impression in the
hospital chart and then we woulddictate a preliminary report and
then they would over read it forus.
But it definitely helps you as astenographer to be more aware of
your scanning and your ability to identify pathology and to
(10:48):
relay that information in a professional and appropriate
manner that can, you know, end up with reimbursement for it or
for the for the facility. But I think that's great.
But you know, moreover, I think that in your environment and
having the opportunity, I would call it an opportunity to be
(11:09):
able to scan the patient, determine what's going on,
because you're probably also doing a bit of a physical exam
with that and then detailing outof, you know, dictating a
report. Your physicians have to have a
lot of faith and trust in you and you have to have that
highest level of expertise to beable to perform those
(11:31):
responsibilities. And and so that's kudos to you.
Yes. That's probably what makes this
a. Rewarding, right?
Yes, and you know, another another benefit is it really
helps reinforce your learning and understanding of the the
verbiage. So, you know, where I'm
describing this on a tendon is that, you know, it's the the
(11:54):
proximal anterior fibers, you know, like it helps you learn
those things as you're, you know, forced to get them
correct. Right.
But, you know, it's a work in progress with the radiologist.
And, you know, they may have to tweak things a little bit more
initially. But as you go on, the
sonographers are going to get better and better.
And then it is a real time saverfor the radiologist.
(12:16):
Yeah. So you just mentioned that
they'll go behind you and when you're first learning, you know
a lot of tweaks and edits are having to be made.
Do they come and sit down and talk to you and go over those
reports with you and and kind ofhelp build that skill or is that
something you guys do on your own?
Well, initially when we're training new stenographers, you
(12:36):
know, they'll usually have a senior stenographer with them
helping them create the verbiage.
But we also do recommend, you know, going back and looking at
what was changed so that you know how to say it next time,
you know, or a particular doctormight like to phrase something a
particular way and just, you know, file that away for the
next time as well. But where I came, you know, at U
(12:58):
of M, the general stenographers don't, we don't have to create
reports at all because we have residents, you know, we're
teaching institution and they'vecreated practitioners now for
the general side. So they really kind of scan and
then, you know, kind of verballygo back and forth.
But it's not on the stenographerin the end to describe it.
(13:20):
So this is definitely an MSK specific opportunity or or bonus
at our site. Right, absolutely, and you know
MSK is utilizes a lot of dynamicmaneuvers in order to sometimes
see the pathology that you mightnot see and as actually one of
the benefits of utilizing ultrasound over MRI.
(13:41):
So if do you often times have toask a radiologist or one of the
residents to come in to show them dynamically what you're
scanning, or do you take video images to be able to present
that information? We do video clips our our staff
are not always on site. Like I said, we have 3
(14:01):
outpatient clinics that aren't necessarily, you know, have
staff presents. Sometimes they do at the Mr.
sites, but we predominantly workin cineclips now.
We have gotten away from, you know, like 6 still images of a
longitudinal biceps tendon. If we can prove that it's normal
in one cineclip, that's one image that the radiologist has
(14:23):
to look through. And then we take stills to kind
of, you know, document pathologyand and slow them down and be
like, I need you to look here atthis, you know, but the sin
eclipse are kind of where it's at and we do all our dynamics,
you know, on sinning. So they're kind of seeing real
time on an image. What we're, you know, the
movements that we're doing in the room.
Well. That makes sense.
(14:44):
Yeah, Yeah. How about injections, You
mentioned that the PASI believe or are doing the injections.
Do you have Ms. caseinographers that assist them with that or
are they using just performing those on their own with
ultrasound guidance? We, we do not have MSK
stenographers in with them anymore.
We used to do some procedures that are off sites and that
(15:06):
would be the stenographer and the radiologist, but we've kind
of gotten away with away from that.
We have two MSKPA's right now and so they run the procedure
rooms and then they also have, they usually have a fellow
because we have fellows in our department and also a like a
patient care tech. I'm not entirely sure of their
(15:28):
exact title, but there is another person in that helps get
the room set up and you know, get the patient in there and,
and whatnot. So there's usually a few people
already in the room and our PAS are pretty proficient.
So they're really good at what they do and usually between the
fellow and the PA they have it covered.
Yeah, that's fantastic. You've got quite a robust MSK
(15:51):
department there. That's fantastic.
And everyone is under a staff, you know, so the staff,
especially for the procedures, would be available, you know, if
they were needed, Yeah. Yeah.
Well, I think that, you know, just hearing your, the evolution
of your career and, and moving from general into MSK and, and
(16:12):
many of the opportunities that you have had the advantage of
taking advantage of that has it should be exciting for for our
sonographers who may be listening, but also our other
healthcare providers that the you know, the benefits of using
ultrasound and MSK are so wide and broad in helping our
(16:34):
patients. So I know some people may be a
little bit overwhelmed, especially the non physician.
Yeah, the sonographers that likeyou said that don't know the
anatomy. I was in X-ray before I went
into ultrasound. So I got a little bit of the
Bony, you know, you have, you know your Bony anatomy, but you
don't learn about the ligaments and the tendons and, and there's
(16:55):
a lot of names of structures that are very difficult to
pronounce, let alone fine. So.
The nerves. Yeah, the nerves.
The nerves. So, so, you know, I think it's,
it's something that's that definitely is doable.
And you know, if you're interested in the
musculoskeletal, you know, worldthat it just, you're just going
(17:18):
to have to take the time to, like you said, memorize the
anatomy and like anything, there's a learning curve to it.
So you just have to be patient and scan, scan scan, right?
Yes, but it's really interestingand it's really cool and you
know, I loved general and I do miss babies.
I miss obstetric ultrasound thatwas kind of like one of my
favorites and liver dopplers. But MSP is is really fun.
(17:42):
It's interesting to see, you know, these, you know, tendons
connecting the muscle to the bone and how they work.
And there is some oncology stuffto it, but there's also a
significant decrease from general.
And some of that stuff can get pretty heavy.
And MSP is kind of like most things aren't, they're painful,
(18:06):
but they're not going to end your life.
So this is kind of a lighter field to be in in that regard.
And it's, it's, it's fun, it's interesting and it's fun.
So I would encourage anybody, you know, with a with a little
bit of interest, it's really just only going to grow in
demand. So it would benefit people to,
you know, take that leap into learning it.
Yes, absolutely. It is a very rapidly growing
(18:29):
area of our profession, so I know that some of the
stenographers out there might also be thinking about what
other opportunities might be outthere related to being MSK
ultrasound trained. Yeah.
So once you're kind of proficient and efficient in
this, there's a lot of differentopportunities.
Obviously, the biggest gap in our world is training.
(18:52):
So there's just not enough people that know how to do it.
So that there's a lot of opportunities there because
clinicians and insurance companies have learned that, you
know, this is effective and efficient.
And in fact, some insurance companies have now kind of
mandated that you start with an MSK ultrasound before they'll
give authorization for Mr. So they, you know, it needs to get
(19:14):
done. So it's really needed in all
imaging settings at this point. I kind of started doing hands on
training courses teaching FM in about 2007 and that is still a
need nationally. Like I'm sure you guys know that
you probably have more people that wanna come than you have
space score. So that's an opportunity there.
(19:37):
There's also smaller independentimaging clinics that would wanna
offer this. I worked at one of those for
about 10 years and did MSK ultrasound for them, kind of
like as a side doc in addition to U of M So there's clinics
like that, there's private teaching.
Sometimes people will want you to come in and teach at their
hospital if you're proficient inthis, to help their techs along
(19:58):
or, you know, creating educational materials, things
like that. So there's a lot of different
extra things that you can do once you get skilled in this for
sure. Yeah, I mean, Heidi herself has
written to CME Vitals. Right.
And they're excellent, by the way.
Thank you. Yeah, yeah.
So definitely check those out. Yes.
(20:20):
She's an amazing writer. She really is.
You can your your knowledge definitely comes through in in
your articles that you've written with us.
Not only that. They're helpful.
Not only that, but also you justhave this way of explaining
something that even though it's it may be complicated and it's
hard to visualize, you just havea way of saying it where it's
(20:44):
like, oh, OK, I, I can see that.Like I can close my eyes and see
that. So that's a definite gift, but.
Absolutely. Well, that's my hope.
And you know, we have fellows every year in our department.
So, you know, since the since day one, we've kind of, you
know, I think I had one year to learn and then I was immediately
teaching at conferences and teaching fellows.
And you know, we've brought up, we started with four then and
(21:08):
now we're up to 9 and we've had a few come and go.
So, you know, I kind of been teaching on the regular.
So practice makes perfect, right.
That's true. Or at least trying trying to get
there. One you're in, that's.
Crazy. Yeah, That definitely put you in
the position. You know your stuff, right?
So, you know, we've heard from you.
You were very fortunate to be taken under the wing of a
(21:31):
amazing radiology staff who just, you know, spent the time
working with you and teaching you.
But there's a lot of people out there who may be saying to
themselves right now, I really want to learn to do this.
I would love to see my career change, and I would like to go
after MSK who maybe don't have those same opportunities within
their departments. So outside of learning on the
(21:53):
job, what are some other recommended ways to learn MSK
ultrasound in your opinion? Yeah.
So you know, the one-on-one training with someone who's
proficient at is most ideal. And if that can't be in your
institution for whatever reason,I would suggest to go to as many
hands on conferences as possiblelike the ones you guys offer at
(22:13):
Gulf Coast. That really is hugely beneficial
because you're getting lecture, you're getting, you know, your
hands on and you have someone there helping you kind of with
your technique. So those that's a great option.
John Jacobson's book The Fundamentals of Musculoskeletal
Ultrasound is the best in my opinion.
(22:33):
It's just a fantastic foundationof knowledge and information to
build on and it's very clear andconcise and not super
overwhelming with jargon like sometimes literature can be.
So I think and he has protocols in there and things.
So, you know, for the for the book wise, that's kind of what I
would recommend. There's also a lot of online
(22:56):
offerings at different places, like at Gulf Coast.
They have a lot of online CM ES and just educational materials
and videos. I would get my hands on those
and just watch those and practice.
You know, like if you have your book and you know, have the
anatomy in front of you, if you can just grab a fellow
stenographer or anybody available and just, you know,
(23:17):
practice and take a look and tryto find where these tendons are
going and where these structuresare located and try to make your
imaging match up to what you're seeing.
Just, you know, practice is key.This is a mastery of a whole new
set of anatomy, whole new set ofpathology, a whole new imaging
technique. So it really honestly does take
years to master. Don't let that intimidate you.
(23:38):
It is rewarding and worth it, but just be patient and keep
learning. I still learn every day.
There's always something new to learn, some new technology or a
new technique or a structure that we've never been asked to
look at before. So, you know, it's an ongoing
learning process. But those, those would be my
suggestions. I don't think there's an MSK
(24:00):
school just yet, but those wouldbe a very good start, you know,
if you couldn't do it inside your own institution.
Yeah. No, I agree.
Those are all really good opportunities to get your self
immersed into it. It's really start diving in.
And I agree, you have to do the didactic same, the hand hands on
together, which can be difficultfor somebody who doesn't have
(24:22):
someone to take them under theirwing.
But like you said, grab a friend, start looking at their
anatomy, comparing it to what you're seeing in the literature
and the textbook, such a reading, and see if you can
start putting it all together. Well, there's a will.
There's a way. Absolutely.
Absolutely, yes, totally agree. And you know, you're really
going to have to have a staff get on board with this too, you
know, and ideally, you know, musculoskeletal radiologist who,
(24:46):
you know, has the the thorough background in the anatomy and
can kind of help translate between ultrasound and Mr. you
know, what are we seeing with, you know, get confirmation if
necessary. But that, you know, is a great
way to build to have that that team work there.
And I imagine that they have to be invested and believe in the
benefit of ultrasound. And for, and I, I know that
(25:08):
it's, it's been around for a while, obviously, but I know
that that some departments maybearen't quite there yet.
So maybe, you know, gauge that as well and be willing to move
on if this is something you wantto do and maybe your facility
isn't 100% there, right. You know, have those
conversations, try to bring themthere.
And then, you know, if you have to, you just have to be willing
(25:29):
to move on and make changes so you can grow and develop.
Yeah. Yeah, it's going to need to be
done, you know, and back again to the insurance thing.
Like this is not going away. It's an effective tool.
A lot of times we can get to thefinal diagnosis just with what
we're doing. It's more comfortable for the
patients. It's, you know, more cost
effective. Like this is not going to stop
(25:49):
being a thing. So, you know, there are places
that are going to need to get onboard and yeah, I would, I would
gravitate towards those. Yeah, I totally agree with that.
I was just going to say that, you know, whether facilities
want to invest their time and money into training their
stenographers or cross training their stenographers, the
(26:11):
insurance part of it is going to, you know, somewhat force
that issue. And and it's going to require
that the management is on board and that they're supportive and
to recognize that this is a new specialty and has a whole nother
set. It's a whole new skill set that
takes time to learn and, you know, practice.
(26:32):
We always say it's the friends and family plan.
You know, even if you're not, don't have somebody there at
your facility to give you the Technical Support, at least if
you have the supportive management to give you the
opportunity to purchase the educational resources that you
need. Attend a hands on workshop where
you can get that skill set so that you can come back and then
(26:55):
continue practicing. Maybe not even on real patients
at first, but or doing patients,but having them over read.
And maybe you're not billing forthem right away until you get to
that level of proficiency. But that's, it's the whole
friends and family plan. You have your, your own body
that you can scan yours as well.I remember when I first learned
(27:16):
how to do DVT, scan caffeines, Iwas scanning my caffeines all
the time. So that was many moons ago.
But you know, it's the same thing whenever you learn a new
technique, it takes time. You have to invest the time on
your own And and that's it's notall on your facility, it's on
you as well as a stenographer. You have to be willing to invest
the time to read the books and John Jacobson's book is
(27:39):
excellent and to invest your time into to the learning aspect
of it and practice. And if it's a team effort.
So if everybody works together, then should be able to get where
you want to be and relatively you know the shortest period of
time possible for a new technique.
Yeah, and you have to start somewhere.
So, and you know, that's a greatplace to start.
(28:01):
Like you don't have to start offat level time.
You can start off, you know, scanning yourself and like you
said, not billing for things, but just taking a look.
You know, that's probably important when you have staff on
board, you know, with what you're doing.
But no, I I agree with all that.Yeah, and it keeps your keeps
your career exciting, right And to learn something new and
(28:22):
broaden your education. And you know, even though we've
been in the ultrasound profession for a lot of years,
we learn new things all the time.
So it's that's definitely part of the ultrasound profession is
that once you stop learning, then you're going to become
stagnant and somebody's going totake your place, so.
(28:42):
Well, it's boring and it's just do the same thing every day
right outside your comfort zone.Find something challenging and
go after it. Absolutely.
I'm always happiest when I come home after a day of going well,
I learned so much today. Like those are the days that
really fulfill me. Absolutely.
I agree and I love and that's something that I, you know, ask
(29:03):
for our radiologists at work. Do you know, on the lead side,
like what can I do to make, you know, keep us, you know, cutting
edge and keep going? So I created a Acme conference
at our, at my work. So a few times a year I'll, you
know, gather all of our interesting cases and the
literature that corresponds to it.
And, you know, because not everybody sees everybody else's
(29:25):
case, right? We've got 9 stenographers
running. So this is a way to like, you
know, share, share knowledge of it.
And when our radiologists go to outside conferences, I'm like,
please bring this back. Like we want to learn.
Like that's the exciting part ofour job is that it's not
stagnant. You know, there's always
something new and, you know, interesting.
So I love that part. I love my job this.
(29:48):
I'm very blessed in this. That's fantastic.
I think this has been a really important topic because we do
like to talk with different stenographers who have different
roles in our profession and havegone from, you know, being a
general stenographer to other opportunities.
And there's a lot of people, especially students who are just
starting out that don't really, they may not realize all the
(30:12):
different opportunities that areavailable to them as they grow
in their profession. And so it's always nice talking
with people like yourself that have taken the extra steps to
learn new things and have grown within their profession and, and
are clearly really happy and satisfied.
So we really, really appreciate you joining us today and talking
(30:34):
with us. My pleasure.
Yeah, I love talking about this.So I hope everybody can get some
excitement for it because it's needed and it's it's really
great. Yeah.
And it's here to stay and we're just going to continue growing.
So and we hope that all of our listeners will continue joining
us as well and, and checking, checking us out because we're
(30:56):
always coming out with new things to offer to help in the,
in the educational end of things.
So I want to thank you, Heidi for joining us today.
It's been a fantastic time discussing this with you and
want to thank our listeners for joining us as well.
And be sure to stay tuned for additional episodes and check us
out on YouTube where you can seeour live Cam of Downtown Saint
(31:18):
Pete. We're just talking about that
earlier. It's beautiful, sunny, 80° out
today. Be sure to watch our podcast
videos and check out our hot tubs as well.
And if you have any suggestions for content, please e-mail us at
the Sonography lounge@gmail.com.And we'd also love for you to
get social with us. So follow us on Twitter and
Instagram. And we hope that you have
(31:39):
enjoyed today's program and havea great day and happy scanning.
Yes, Thank you, Heidi. Thank you, Heidi.
Thank you ladies for having me. Yes, happy scanning everybody.
Thanks for listening to The Sonography Lounge.
Don't forget, if you like this episode, please subscribe and
leave us a review on iTunes, Spotify, or wherever you get
(32:01):
your podcasts. You can also find us on
Instagram at Sonography Lounge and Twitter at Sonography LNG.
If you have any questions, comments, or topic suggestions,
feel free to send an e-mail to us at
sonographylounge@gmail.com. Have a great week and scan,
(32:25):
scan, scan.
Recording from the Sunshine CitySt.
Petersburg, FL overlooking beautiful Tampa Bay, this is the
Sonography Lounge. Sponsored by Gulf Coast
Ultrasound Institute. This podcast is dedicated to
medical professionals and patients around the world
interested in diagnostic and interventional ultrasound.
(00:25):
Our podcast will discuss everything ultrasound from news,
trends, career paths, new technology, and industry
updates. Hosted by Lori Green and Tricia
Rio of Gulf Coast Ultrasound Institute, they bring over 4
decades of experience in the ultrasound profession and are
here to guide you through this journey.
Now sit back, relax and enjoy. Hey, everyone, and thank you for
(00:51):
joining us in the Sonography Lounge where we discuss all
things ultrasound. I'm Tricia Rio, and I'm joined
by my Co host, Lori Green. Hey, everybody.
And today's episode as part of our careers in sonography, we'll
be chatting with Heidi Erik about a day in the life of an
MSK sonographer. Welcome, Heidi.
Hi, thanks for having me. Yes, thank you for joining us.
(01:13):
Yeah, absolutely. We're so happy to have Heidi
with us today, and why don't we just get started off by having
you tell us a little bit about how you got started in MSK
Ultrasound. All right.
Well, I have been doing MSK ultrasound for 17 years now at
the University of Michigan. I started there as a general
(01:34):
stenographer and about that timeDoctor Jacobson and some others
were starting to grow ultrasoundin the MSK department.
So they took up a few texts initially to train with them and
then when I was about six years in, I went up to train with the
three original tax and the MSK radiologist did that for about
(01:55):
10 years and decided to give up general and go full time MSK.
We just don't have enough peoplethat know how to do it.
So I was kind of needed a littlebit more consistently.
And then a couple years ago, I also took on the lead
stenographer role in our department and that kind of
brings us up to now. That's fantastic there.
You're all right. There's very few experienced MSK
(02:19):
stenographers. So to have that opportunity to
learn and train, especially withexperts like Doctor Jacobson to
and you know, put that skill into into practice is amazing.
It's a really fantastic opportunity.
Yeah, I mean, I just think abouteverything you have to learn to
become an MSK stenographer. You know, you go into it, if
(02:40):
you're already a stenographer, you already have a really strong
basic knowledge of ultrasound, but then you have to learn all
of that anatomy and Physiology of the musculoskeletal system.
So I'm sure that's plays a role into how it differs.
But can you tell us, just in general, how does being an MSK
stenographer different from being a general stenographer on
your daily basis? Well, yeah, like you said, it's
(03:02):
a it's a whole new set of anatomy pathology.
So that learning that is an enormous undertaking.
And I myself had no previous X-ray experience where you learn
some of these like Bony landmarks and things.
So I had to learn, you know, from scratch.
I didn't know what a tuberosity was or anything.
And those are very important forMSK imaging.
You know, you have to learn all this new anatomy, learn the
(03:23):
pathologies and then the actual technique.
So instead of like doing broad strokes with the curvilinear
probe, looking over these, you know, kind of wider areas like
the liver, we're looking for an Adamine pathology and a very
tiny footprint. So we're looking for very
complex anatomy that can be likein the space of a couple
centimeters. So we have to really train our
(03:44):
eye to slow down and look for really subtle abnormalities.
And you know, just as as different as the anatomy and
pathology is, you know, our approach has to be a little bit
different to to the way that we kind of get in there and
evaluate for things. Yeah.
And would you say it was easier to learn by doing scanning, or
did you find that sitting down and kind of reviewing anatomy
(04:08):
and Physiology from a book helped you more at first?
It really is a, a, a combinationof those things.
So you have to, you have to memorize these things, right.
So all of that didactic book stuff is important because it's
all new terms and all new structures.
And, you know, we, there wasn't really a lot of must be scaled
to ultrasound books back in the early 2000s.
(04:29):
So like the Netter orthopedic anatomy was like our Bible and
we used to like color, do coloring pages just to see where
these tendons went, you know, from the muscle to the bone.
But then yes, obviously, like the hands on.
So sitting with someone who knows what they're looking at
and then, you know, like practicing doing post scanning
and, you know, scanning friends or just whatever it's, you know,
(04:51):
just as a general photographer would do.
But just, you know, it's a wholenother set of anatomy there.
But yeah, the hands on is very important as well.
Yeah. Yeah, absolutely.
It definitely is a different scanning technique compared to
doing abdominal or OBGYN, you know vascular you making those a
little subtler movements when you're scanning, you know
(05:14):
between vessels and so forth. But definitely MSK has its own
little. Well, then you're scanning on
top of bone. So I even, we just had our
blended MSK course these last two days.
We just wrapped up at 12 O clockand I heard one of the
instructors telling the participant who is a
sonographer, it's you have to use your fingers to really plant
(05:35):
yourself, to give yourself something to hold onto because
otherwise you're just going to keep sliding right off of that
bone. And she said that she goes, it's
so different than scanning everything else that I scan
because you do you just slide right off.
Right. Right.
And, you know, the movements aremuch smaller when we, you know,
take on new stenographers to train, you know, they're they,
you just move so fast because you're used to like covering a,
(05:58):
a bigger area. But when we're really talking
about like this tendon is, is 2cm and you have to, there's a
lot of the tendon that you have to look through, even though
it's so small, it's really like the hand movements are very,
very subtle. Otherwise you're gonna come
right off and be all the way outof it.
Yeah. Yeah, very easy to miss things
if you're not scanning slowly. Yeah.
(06:22):
In parallel, we learned that word right, the anisotropy word.
Yeah. Yeah.
So perpendicular, that's a big structure, right?
Yeah. Yeah, that's a big one.
First you have to learn how to say the word.
Yeah. Then you'd have to learn how to
avoid. It's a whole new set of
everything, vocabulary and everything.
(06:45):
That's right. As Tricia was talking to you
about how it's different from being a general stenographer to
an MSK stenographer, how the thedaily activities and your
patient throughput and so forth,I'm sure is a little bit
different than in the general ultrasound department.
So how does what does a day in an MSK stenographers department
(07:08):
look like as far as that goes? Yeah, it is.
It is slightly different. So at my institution at
University of Michigan, we have a very large general department.
We have about 70 stenographers, but we also have a pretty good
MSK department as well. So we have 9 MSK stenographers,
we have 6 full time rooms running between the hospital and
(07:29):
three outpatient centers and then there's another 2 rooms
running run by the P As for ultrasound guided procedures
like general, we would scan and then we in our hospital show our
studies either to a practitioneror a radiologist.
For the MSK, it's the radiologists themselves and
they'll we'll look over things and determine if we need to post
(07:52):
scan for any additional imaging and then we also dictate.
So our MSK technologists have been trained to dictate cases
and that really helps save time for the staff that they can just
kind of edit and sign off as they need.
Occasionally we also will give verbal reports to clinicians if
we have like an in house add on or if the report needs to get to
(08:17):
the doctor and the our staff is not on site or if they're busy
on another service or something.Yeah, I know that that probably
is. You're learning how to perform
ultrasound in musculoskeletal applications.
Learning how to dictate it, I would imagine really helps you
more than it hinders you. Because I, when I learned
(08:39):
vascular, that's how I learned was I had to dictate my own
studies into a phone and call number and dictate it and then
it would be reviewed by the radiologist or vascular surgeon
who was on call. And I found that that really
helped me. So do you guys feel like
dictating your cases as more of a burden or a benefit in your
department? Yeah, it's, it's definitely a
(09:00):
huge benefit. So our MSK taxi, they dictate,
but it's one thing to kind of like scan and figure out, you
know, what's going on to create an imaging story or to explain
it to a radiologist. But you know, it's a whole other
thing to put this in professional verbiage for the
clinician or medical legal documentation.
(09:21):
So you have to be really familiar with the pathologies
and how to describe them in detail.
You also have to be very familiar with the differential
diagnosis that you might need togive.
Sometimes we have to recommend further imaging on something.
So over time you kind of learn what would be the most
appropriate study to best suggest for that.
But you know, at the end of the day, the doctor still has the
(09:43):
the final edit to sign off. So it is, you know, their name
on the report. But we have found that it just
really helps you grow in your learning and understanding that
you're not just taking the picture.
You're able to describe, you know, professionally how to
describe this and, and put it ina report for the, the doctor and
the patient's gonna be reading that later too, so.
(10:04):
Yeah. And it's very similar to what we
do with our worksheets, right? You do your technical
impression, it's just a little bit more.
I don't know. It's more a little more
elaborate because you do. Have to.
You know, generate a a report that you know more it.
Describes. It in more detail and I know I
(10:24):
did the same thing and when I worked with a vascular surgeon
that you know, we wrote a technical impression in the
hospital chart and then we woulddictate a preliminary report and
then they would over read it forus.
But it definitely helps you as astenographer to be more aware of
your scanning and your ability to identify pathology and to
(10:48):
relay that information in a professional and appropriate
manner that can, you know, end up with reimbursement for it or
for the for the facility. But I think that's great.
But you know, moreover, I think that in your environment and
having the opportunity, I would call it an opportunity to be
(11:09):
able to scan the patient, determine what's going on,
because you're probably also doing a bit of a physical exam
with that and then detailing outof, you know, dictating a
report. Your physicians have to have a
lot of faith and trust in you and you have to have that
highest level of expertise to beable to perform those
(11:31):
responsibilities. And and so that's kudos to you.
Yes. That's probably what makes this
a. Rewarding, right?
Yes, and you know, another another benefit is it really
helps reinforce your learning and understanding of the the
verbiage. So, you know, where I'm
describing this on a tendon is that, you know, it's the the
(11:54):
proximal anterior fibers, you know, like it helps you learn
those things as you're, you know, forced to get them
correct. Right.
But, you know, it's a work in progress with the radiologist.
And, you know, they may have to tweak things a little bit more
initially. But as you go on, the
sonographers are going to get better and better.
And then it is a real time saverfor the radiologist.
(12:16):
Yeah. So you just mentioned that
they'll go behind you and when you're first learning, you know
a lot of tweaks and edits are having to be made.
Do they come and sit down and talk to you and go over those
reports with you and and kind ofhelp build that skill or is that
something you guys do on your own?
Well, initially when we're training new stenographers, you
(12:36):
know, they'll usually have a senior stenographer with them
helping them create the verbiage.
But we also do recommend, you know, going back and looking at
what was changed so that you know how to say it next time,
you know, or a particular doctormight like to phrase something a
particular way and just, you know, file that away for the
next time as well. But where I came, you know, at U
(12:58):
of M, the general stenographers don't, we don't have to create
reports at all because we have residents, you know, we're
teaching institution and they'vecreated practitioners now for
the general side. So they really kind of scan and
then, you know, kind of verballygo back and forth.
But it's not on the stenographerin the end to describe it.
(13:20):
So this is definitely an MSK specific opportunity or or bonus
at our site. Right, absolutely, and you know
MSK is utilizes a lot of dynamicmaneuvers in order to sometimes
see the pathology that you mightnot see and as actually one of
the benefits of utilizing ultrasound over MRI.
(13:41):
So if do you often times have toask a radiologist or one of the
residents to come in to show them dynamically what you're
scanning, or do you take video images to be able to present
that information? We do video clips our our staff
are not always on site. Like I said, we have 3
(14:01):
outpatient clinics that aren't necessarily, you know, have
staff presents. Sometimes they do at the Mr.
sites, but we predominantly workin cineclips now.
We have gotten away from, you know, like 6 still images of a
longitudinal biceps tendon. If we can prove that it's normal
in one cineclip, that's one image that the radiologist has
(14:23):
to look through. And then we take stills to kind
of, you know, document pathologyand and slow them down and be
like, I need you to look here atthis, you know, but the sin
eclipse are kind of where it's at and we do all our dynamics,
you know, on sinning. So they're kind of seeing real
time on an image. What we're, you know, the
movements that we're doing in the room.
Well. That makes sense.
(14:44):
Yeah, Yeah. How about injections, You
mentioned that the PASI believe or are doing the injections.
Do you have Ms. caseinographers that assist them with that or
are they using just performing those on their own with
ultrasound guidance? We, we do not have MSK
stenographers in with them anymore.
We used to do some procedures that are off sites and that
(15:06):
would be the stenographer and the radiologist, but we've kind
of gotten away with away from that.
We have two MSKPA's right now and so they run the procedure
rooms and then they also have, they usually have a fellow
because we have fellows in our department and also a like a
patient care tech. I'm not entirely sure of their
(15:28):
exact title, but there is another person in that helps get
the room set up and you know, get the patient in there and,
and whatnot. So there's usually a few people
already in the room and our PAS are pretty proficient.
So they're really good at what they do and usually between the
fellow and the PA they have it covered.
Yeah, that's fantastic. You've got quite a robust MSK
(15:51):
department there. That's fantastic.
And everyone is under a staff, you know, so the staff,
especially for the procedures, would be available, you know, if
they were needed, Yeah. Yeah.
Well, I think that, you know, just hearing your, the evolution
of your career and, and moving from general into MSK and, and
(16:12):
many of the opportunities that you have had the advantage of
taking advantage of that has it should be exciting for for our
sonographers who may be listening, but also our other
healthcare providers that the you know, the benefits of using
ultrasound and MSK are so wide and broad in helping our
(16:34):
patients. So I know some people may be a
little bit overwhelmed, especially the non physician.
Yeah, the sonographers that likeyou said that don't know the
anatomy. I was in X-ray before I went
into ultrasound. So I got a little bit of the
Bony, you know, you have, you know your Bony anatomy, but you
don't learn about the ligaments and the tendons and, and there's
(16:55):
a lot of names of structures that are very difficult to
pronounce, let alone fine. So.
The nerves. Yeah, the nerves.
The nerves. So, so, you know, I think it's,
it's something that's that definitely is doable.
And you know, if you're interested in the
musculoskeletal, you know, worldthat it just, you're just going
(17:18):
to have to take the time to, like you said, memorize the
anatomy and like anything, there's a learning curve to it.
So you just have to be patient and scan, scan scan, right?
Yes, but it's really interestingand it's really cool and you
know, I loved general and I do miss babies.
I miss obstetric ultrasound thatwas kind of like one of my
favorites and liver dopplers. But MSP is is really fun.
(17:42):
It's interesting to see, you know, these, you know, tendons
connecting the muscle to the bone and how they work.
And there is some oncology stuffto it, but there's also a
significant decrease from general.
And some of that stuff can get pretty heavy.
And MSP is kind of like most things aren't, they're painful,
(18:06):
but they're not going to end your life.
So this is kind of a lighter field to be in in that regard.
And it's, it's, it's fun, it's interesting and it's fun.
So I would encourage anybody, you know, with a with a little
bit of interest, it's really just only going to grow in
demand. So it would benefit people to,
you know, take that leap into learning it.
Yes, absolutely. It is a very rapidly growing
(18:29):
area of our profession, so I know that some of the
stenographers out there might also be thinking about what
other opportunities might be outthere related to being MSK
ultrasound trained. Yeah.
So once you're kind of proficient and efficient in
this, there's a lot of differentopportunities.
Obviously, the biggest gap in our world is training.
(18:52):
So there's just not enough people that know how to do it.
So that there's a lot of opportunities there because
clinicians and insurance companies have learned that, you
know, this is effective and efficient.
And in fact, some insurance companies have now kind of
mandated that you start with an MSK ultrasound before they'll
give authorization for Mr. So they, you know, it needs to get
(19:14):
done. So it's really needed in all
imaging settings at this point. I kind of started doing hands on
training courses teaching FM in about 2007 and that is still a
need nationally. Like I'm sure you guys know that
you probably have more people that wanna come than you have
space score. So that's an opportunity there.
(19:37):
There's also smaller independentimaging clinics that would wanna
offer this. I worked at one of those for
about 10 years and did MSK ultrasound for them, kind of
like as a side doc in addition to U of M So there's clinics
like that, there's private teaching.
Sometimes people will want you to come in and teach at their
hospital if you're proficient inthis, to help their techs along
(19:58):
or, you know, creating educational materials, things
like that. So there's a lot of different
extra things that you can do once you get skilled in this for
sure. Yeah, I mean, Heidi herself has
written to CME Vitals. Right.
And they're excellent, by the way.
Thank you. Yeah, yeah.
So definitely check those out. Yes.
(20:20):
She's an amazing writer. She really is.
You can your your knowledge definitely comes through in in
your articles that you've written with us.
Not only that. They're helpful.
Not only that, but also you justhave this way of explaining
something that even though it's it may be complicated and it's
hard to visualize, you just havea way of saying it where it's
(20:44):
like, oh, OK, I, I can see that.Like I can close my eyes and see
that. So that's a definite gift, but.
Absolutely. Well, that's my hope.
And you know, we have fellows every year in our department.
So, you know, since the since day one, we've kind of, you
know, I think I had one year to learn and then I was immediately
teaching at conferences and teaching fellows.
And you know, we've brought up, we started with four then and
(21:08):
now we're up to 9 and we've had a few come and go.
So, you know, I kind of been teaching on the regular.
So practice makes perfect, right.
That's true. Or at least trying trying to get
there. One you're in, that's.
Crazy. Yeah, That definitely put you in
the position. You know your stuff, right?
So, you know, we've heard from you.
You were very fortunate to be taken under the wing of a
(21:31):
amazing radiology staff who just, you know, spent the time
working with you and teaching you.
But there's a lot of people out there who may be saying to
themselves right now, I really want to learn to do this.
I would love to see my career change, and I would like to go
after MSK who maybe don't have those same opportunities within
their departments. So outside of learning on the
(21:53):
job, what are some other recommended ways to learn MSK
ultrasound in your opinion? Yeah.
So you know, the one-on-one training with someone who's
proficient at is most ideal. And if that can't be in your
institution for whatever reason,I would suggest to go to as many
hands on conferences as possiblelike the ones you guys offer at
(22:13):
Gulf Coast. That really is hugely beneficial
because you're getting lecture, you're getting, you know, your
hands on and you have someone there helping you kind of with
your technique. So those that's a great option.
John Jacobson's book The Fundamentals of Musculoskeletal
Ultrasound is the best in my opinion.
(22:33):
It's just a fantastic foundationof knowledge and information to
build on and it's very clear andconcise and not super
overwhelming with jargon like sometimes literature can be.
So I think and he has protocols in there and things.
So, you know, for the for the book wise, that's kind of what I
would recommend. There's also a lot of online
(22:56):
offerings at different places, like at Gulf Coast.
They have a lot of online CM ES and just educational materials
and videos. I would get my hands on those
and just watch those and practice.
You know, like if you have your book and you know, have the
anatomy in front of you, if you can just grab a fellow
stenographer or anybody available and just, you know,
(23:17):
practice and take a look and tryto find where these tendons are
going and where these structuresare located and try to make your
imaging match up to what you're seeing.
Just, you know, practice is key.This is a mastery of a whole new
set of anatomy, whole new set ofpathology, a whole new imaging
technique. So it really honestly does take
years to master. Don't let that intimidate you.
(23:38):
It is rewarding and worth it, but just be patient and keep
learning. I still learn every day.
There's always something new to learn, some new technology or a
new technique or a structure that we've never been asked to
look at before. So, you know, it's an ongoing
learning process. But those, those would be my
suggestions. I don't think there's an MSK
(24:00):
school just yet, but those wouldbe a very good start, you know,
if you couldn't do it inside your own institution.
Yeah. No, I agree.
Those are all really good opportunities to get your self
immersed into it. It's really start diving in.
And I agree, you have to do the didactic same, the hand hands on
together, which can be difficultfor somebody who doesn't have
(24:22):
someone to take them under theirwing.
But like you said, grab a friend, start looking at their
anatomy, comparing it to what you're seeing in the literature
and the textbook, such a reading, and see if you can
start putting it all together. Well, there's a will.
There's a way. Absolutely.
Absolutely, yes, totally agree. And you know, you're really
going to have to have a staff get on board with this too, you
know, and ideally, you know, musculoskeletal radiologist who,
(24:46):
you know, has the the thorough background in the anatomy and
can kind of help translate between ultrasound and Mr. you
know, what are we seeing with, you know, get confirmation if
necessary. But that, you know, is a great
way to build to have that that team work there.
And I imagine that they have to be invested and believe in the
benefit of ultrasound. And for, and I, I know that
(25:08):
it's, it's been around for a while, obviously, but I know
that that some departments maybearen't quite there yet.
So maybe, you know, gauge that as well and be willing to move
on if this is something you wantto do and maybe your facility
isn't 100% there, right. You know, have those
conversations, try to bring themthere.
And then, you know, if you have to, you just have to be willing
(25:29):
to move on and make changes so you can grow and develop.
Yeah. Yeah, it's going to need to be
done, you know, and back again to the insurance thing.
Like this is not going away. It's an effective tool.
A lot of times we can get to thefinal diagnosis just with what
we're doing. It's more comfortable for the
patients. It's, you know, more cost
effective. Like this is not going to stop
(25:49):
being a thing. So, you know, there are places
that are going to need to get onboard and yeah, I would, I would
gravitate towards those. Yeah, I totally agree with that.
I was just going to say that, you know, whether facilities
want to invest their time and money into training their
stenographers or cross training their stenographers, the
(26:11):
insurance part of it is going to, you know, somewhat force
that issue. And and it's going to require
that the management is on board and that they're supportive and
to recognize that this is a new specialty and has a whole nother
set. It's a whole new skill set that
takes time to learn and, you know, practice.
(26:32):
We always say it's the friends and family plan.
You know, even if you're not, don't have somebody there at
your facility to give you the Technical Support, at least if
you have the supportive management to give you the
opportunity to purchase the educational resources that you
need. Attend a hands on workshop where
you can get that skill set so that you can come back and then
(26:55):
continue practicing. Maybe not even on real patients
at first, but or doing patients,but having them over read.
And maybe you're not billing forthem right away until you get to
that level of proficiency. But that's, it's the whole
friends and family plan. You have your, your own body
that you can scan yours as well.I remember when I first learned
(27:16):
how to do DVT, scan caffeines, Iwas scanning my caffeines all
the time. So that was many moons ago.
But you know, it's the same thing whenever you learn a new
technique, it takes time. You have to invest the time on
your own And and that's it's notall on your facility, it's on
you as well as a stenographer. You have to be willing to invest
the time to read the books and John Jacobson's book is
(27:39):
excellent and to invest your time into to the learning aspect
of it and practice. And if it's a team effort.
So if everybody works together, then should be able to get where
you want to be and relatively you know the shortest period of
time possible for a new technique.
Yeah, and you have to start somewhere.
So, and you know, that's a greatplace to start.
(28:01):
Like you don't have to start offat level time.
You can start off, you know, scanning yourself and like you
said, not billing for things, but just taking a look.
You know, that's probably important when you have staff on
board, you know, with what you're doing.
But no, I I agree with all that.Yeah, and it keeps your keeps
your career exciting, right And to learn something new and
(28:22):
broaden your education. And you know, even though we've
been in the ultrasound profession for a lot of years,
we learn new things all the time.
So it's that's definitely part of the ultrasound profession is
that once you stop learning, then you're going to become
stagnant and somebody's going totake your place, so.
(28:42):
Well, it's boring and it's just do the same thing every day
right outside your comfort zone.Find something challenging and
go after it. Absolutely.
I'm always happiest when I come home after a day of going well,
I learned so much today. Like those are the days that
really fulfill me. Absolutely.
I agree and I love and that's something that I, you know, ask
(29:03):
for our radiologists at work. Do you know, on the lead side,
like what can I do to make, you know, keep us, you know, cutting
edge and keep going? So I created a Acme conference
at our, at my work. So a few times a year I'll, you
know, gather all of our interesting cases and the
literature that corresponds to it.
And, you know, because not everybody sees everybody else's
(29:25):
case, right? We've got 9 stenographers
running. So this is a way to like, you
know, share, share knowledge of it.
And when our radiologists go to outside conferences, I'm like,
please bring this back. Like we want to learn.
Like that's the exciting part ofour job is that it's not
stagnant. You know, there's always
something new and, you know, interesting.
So I love that part. I love my job this.
(29:48):
I'm very blessed in this. That's fantastic.
I think this has been a really important topic because we do
like to talk with different stenographers who have different
roles in our profession and havegone from, you know, being a
general stenographer to other opportunities.
And there's a lot of people, especially students who are just
starting out that don't really, they may not realize all the
(30:12):
different opportunities that areavailable to them as they grow
in their profession. And so it's always nice talking
with people like yourself that have taken the extra steps to
learn new things and have grown within their profession and, and
are clearly really happy and satisfied.
So we really, really appreciate you joining us today and talking
(30:34):
with us. My pleasure.
Yeah, I love talking about this.So I hope everybody can get some
excitement for it because it's needed and it's it's really
great. Yeah.
And it's here to stay and we're just going to continue growing.
So and we hope that all of our listeners will continue joining
us as well and, and checking, checking us out because we're
(30:56):
always coming out with new things to offer to help in the,
in the educational end of things.
So I want to thank you, Heidi for joining us today.
It's been a fantastic time discussing this with you and
want to thank our listeners for joining us as well.
And be sure to stay tuned for additional episodes and check us
out on YouTube where you can seeour live Cam of Downtown Saint
(31:18):
Pete. We're just talking about that
earlier. It's beautiful, sunny, 80° out
today. Be sure to watch our podcast
videos and check out our hot tubs as well.
And if you have any suggestions for content, please e-mail us at
the Sonography lounge@gmail.com.And we'd also love for you to
get social with us. So follow us on Twitter and
Instagram. And we hope that you have
(31:39):
enjoyed today's program and havea great day and happy scanning.
Yes, Thank you, Heidi. Thank you, Heidi.
Thank you ladies for having me. Yes, happy scanning everybody.
Thanks for listening to The Sonography Lounge.
Don't forget, if you like this episode, please subscribe and
leave us a review on iTunes, Spotify, or wherever you get
(32:01):
your podcasts. You can also find us on
Instagram at Sonography Lounge and Twitter at Sonography LNG.
If you have any questions, comments, or topic suggestions,
feel free to send an e-mail to us at
sonographylounge@gmail.com. Have a great week and scan,
(32:25):
scan, scan.
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