Sonography of Superficial Structures Syllabus for 2017-2018
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Course

DMSO-2353-001 Sonography of Superficial Structures

Prerequisites

Course Description

Detailed study of normal and pathological superficial structures as related to scanning techniques, patient history and laboratory data, transducer selection and scanning protocols.

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Department Expectations

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Hours

(3 sem hrs; 3 lec)

Class Type

On Campus Course

Syllabus Information

Textbooks

Abdomen and Superficial Structures, 3^rd Edition, Kawamura & Lunsford

 

Ultrasound Scanning Principles and Protocols 3rd Edition, Betty Bates Tempkin

Supplies

Laptop, Pens, Paper, Textbooks

Student Performance

Sonography of Superficial Structures

CIP Rubric Number Course Title Status Semester Credit Hrs Min Cont Hrs Max Cont Hrs 51.0910 DMSO 2353 Sonography of Superficial Structures Active 3 48 96   Course Level:  Intermediate Course Description:  Detailed study of normal and pathological superficial structures as related to scanning techniques, patient history and laboratory data, transducer selection, and scanning protocols. End-of-Course Outcomes:  Identify sonographic appearance of normal and abnormal superficial structures; identify appropriate scanning technique using standard protocol guidelines; and evaluate patient history and laboratory data as it relates to sonography. Lab Required Cross Reference(s):  DMSO 2053: Sonography of Superficial Structures CIP Code Description:  51.0910  (Diagnostic Medical Sonography/Sonographer and Ultrasound Technician) Year:  2011

 

 

Given the course textbook, personal notes, handouts, and other course materials, the student should be able to do each of the following on a written examination AS EVALUATED BY THE COURSE INSTRUCTOR with an accuracy of not less than 75

 

SUPERFICIAL STRUCTURES

BREAST:

OBJECTIVES:

Describe breast anatomy and sonographic layers

Discuss breast physiology

Know the difference between breast screening and breast imaging

Summarize the indication for the use of ultrasound in breast imaging

Describe the correct technique for imaging the breast using ultrasound

Know how to use methods of identifying and labeling breast anatomy and masses

Identify the sonographic characteristics associated with benign and malignant breast masses

Identify the mammographic characteristic associated with malignant breast masses

Discuss ultrasound-guided interventional procedures

 

HISTORICAL OVERVIEW

Anatomy

     Normal anatomy, Axilla, Tail of Spence, Areola, Subcutaneous Layer, Mammary Layer, Retromammary Layer, Fatty Tissue, Cooper's Ligaments, Acini, Terminal Ductal Lobular Units (TDLU's)

Sonographic Appearance

     Boundaries, Areolar Area, Internal Nipple, Subcutaneous Fat, Cooper's Ligaments, Mammary/Glandular Tissue

Parenchymal Pattern

     Glandular, Fatty, Fibrous, Involution, Pregnancy

Vascular Supply

     Internal Mammary and Anterior Perforating Branches, Lateral Thoracic Arteries, Venous Drainage, Superficial Veins

Lymphatic System

     Flow and Route of Lymph, Axillary Lymph Node Dissection

Male Breast

     Normal Anatomy, Gynecomastia

Physiology of Breast

     Primary Function, Ductal System, Milk Production

Breast Screening

     Diagnostic Breast Imaging, Breast Self-Examination (BSE), Clinical Breast Examination (CBE), Mammography, MRI, Sonography

Clinical Signs and Symptoms of Possible Breast Cancer

     Breast Evaluation, Clinical Assessment, Screening Mammography, Diagnostic Breast Interrogation, Interventional Breast Procedures

Sonographic Evaluation of the Breast

     Indications for Sonographic Evaluation, Palpable Breast Lump, Dense Breasts, Pregnancy or Lactating Patient, Patient with Breast Augmentation, Patient with Difficult or Compromised Mammogram

Sonographic Technique

     Positioning, Scanning Technique, Annotation

Sonographic Characteristic of Breast Masses

     Margins, Disruption of Breast Architecture, Shape, Orientation, Internal Echo Pattern, Attenuation Effects, Mobility, Compressibility, Vascularity

Pathology

     Differential Diagnosis of Breast Masses

     Benign Masses:  Cysts, Fibrocystic Condition, Fibroadenoma, Lipoma, Fat Necrosis, Acute Mastitis, Chronic Mastitis, Abscess, Cystosarcoma Phyllodes, Intraductal Papilloma

     Malignant Conditions:  Atypcial Hyperplasia, Ductal Carcinoma in Situ (DCIS),  Invasive Ductal Carcinoma (IDC),   Lobular Carcinoma in Situ (LCIS),  Invasive Lobular Carcinoma (ILC), Comedocarcinoma, Juvenile Breast Cancer, Papillary Carcinoma, PagetsDisease, Scirrhous Carcinoma, Medullary Carcinoma, Colloid Carcinoma,Tubular Carcinoma

Ultrasound Guided Interventional Procedures: 

     Cyst Aspiration, Fine-needle Aspiration Cytology (FNAC), Drainage Procedures, Preoperative Needle Wire Localization, Large Core Needle Biopsy, Vacuum-Assisted Needle Biopsy, Sentinal Node Biopsy

 

 

THYROID and PARATHYROID GLANDS:

OBJECTIVES:

Describe texture, patterns and size of the normal thyroid and parathyroid glands

Define the relational anatomy of the thyroid and parathyroid

Discuss congenital anomalies that affect the thyroid

Differentiate the sonographic features of pathologic conditions found in the thyroid and parathyroid glands

 

Anatomy

     Size

Relational Anatomy

     Anterior, Posterior, Medial

Blood Supply

Thyroid Physiology and Lab Data

     Euthyroid, Hypothyroidism and Hyperthyroidism

Tests of Thyroid Function

Pathology of Thyroid Gland

     Nodular Thyroid Disease, Hyperplasia, Goiter

     Benign Lesions: Cyst, Adenoma and Sonographic Findings

     Malignant Lesions:  Papillary Carcinoma and Sonographic Findings, Follicular Carcinoma and Sonographic Findings, Medullary Carcinoma and Sonographic Findings, Anaplastic Carcinoma and Sonographic Findings, Lymphoma

     Diffuse Thyroid Disease:  Thyroiditis, Subacute (de Quervains's) Thyroiditis, Hashimoto's Thyroiditis, Graves Disease and Sonographic Findings

Anatomy of Parathyroid Glands

Parathyroid Physiology and Lab Data

Sonographic Evaluation of the Parathyroid Gland

Pathology of Parathyroid Gland:  Primary Hyperparathyroidism, Primary Hyperplasia, Adenoma and Sonographic Findings, Parathyroid Carcinoma, Secondary Hyperparathyroidism

Miscellaneous Neck Masses:  Thyroglassal Duct Cysts, Branchial Cleft Cyst, Abscess and Sonographic Findings, Lymphadenopathy and Sonographic Findings.

 

 

 

SCROTUM:

 

 

OBJECTIVES:

Identify normal anatomy of scrotum

Explain the vascular supply to the scrotal contents

Describe patient positioning, scanning protocol, and technical considerations for ultrasound examination of scrotum

Discuss the role of color and spectral Doppler in scrotal imaging

Describe the ultrasound characteristics of scrotal pathology

 

Anatomy:  Scrotum, Testes, Epididymis, Vas Deferens, Spermatic Cord, Tunica Albuginea, Mediastinum Testes, Tunica Vaginalis, Urethra

Vascular Supply:  Testicular Arteries, Centripetal Arteries, Recurrent Rami, Cremasteric and Differential Arteries, Pudendal Artery

     Venous Drainage:  Pampiniform Plexus, Testicular Veins

Patient Positioning and Scanning Protocol

Testicular Considerations:  Transducer Selection, Color, Spectral, Power Doppler, Gain, Pulse Repetition Frequency, Wall filter, Line Density, Threshold, Packet Size,  Color Box/Region of Interest

Congenital Anomalies:  Cryptorchidism (Undescended Testicle) and Sonographic Findings, Testicular Ectopia, Anorchia, Polyorchidism (Testicular Duplication)

 

 

MUSCULOSKELETAL SYSTEM

OBJECTIVES:

Identify the normal anatomic location and function of the tendon, ligament, muscle, nerves and bursa

Know advantages and disadvantages of sonographic artifacts in Musculoskeletal Imaging

Summarize the basic sonographic examinations of the should, wrist, knee, ankle and foot

Distinguish normal anatomy from common pathologic conditions

 

Anatomy of MSK System:  Normal Anatomy:  Muscle Fibers, Tendons, Nerves

Normal Sonographic Appearance:  Tendons, Ligaments, Muscle, Nerves, Bursa

Artifacts:  Anisotrophy, Reverberation, Refractile Shadowing, Time of Flight Artifact

Sonographic Evaluation of MSK System:  Rotator Cuff, Carpal Tunnel, Achilles Tendon

Pathology of MSK System:  Shoulder Biceps Tendon- Subluxation/dislocation, Rotator Cuff Tears, Partial-Thickness Tear, Full-Thickness Tear, Tendonitis, Muscle Tears, Carpal Tunnel Syndrome

 

 

 

Students Rights and Responsibilities

Student Rights and Responsibilities

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Expected Student Behavior

If a student has a concern with the course instructor, the following “due process” protocol will apply.  The student will follow the protocol steps in the order shown.

1.       Make every effort to resolve the concern directly with the course instructor. The instructor should be contacted by the student before the conclusion of the course.

2.       If the concern cannot be resolved to the satisfaction of the student after meeting with the course instructor, the student should seek satisfaction from the immediate supervisor of the instructor within one week of the student–instructor meeting.

3.       If the concern cannot be resolved to the satisfaction of the student after meeting with the immediate supervisor of the instructor, the student should seek satisfaction from the Allied Health Division chairperson within one week of the student–supervisor meeting.

4.       If the concern cannot be resolved to the satisfaction of the student after meeting with the Allied Health division chairperson, the student should seek satisfaction from Assistant Dean of Career Technical programs within one week of the student–division chairperson meeting.

5.       If the concern cannot be resolved to the satisfaction of the student after meeting with the assistant dean, the student should seek satisfaction from the Vice-President and Dean of Instruction within one week of the student–Assistant Dean meeting.

6.       If the concern cannot be resolved to the satisfaction of the student after meeting with the Vice-President and Dean of Instruction, the student should seek satisfaction from the college President within one week of the student–Vice-President meeting.

7.       If the concern cannot be resolved to the satisfaction of the student after meeting with the President, the student should seek satisfaction from the college Board of Regents at the next regular meeting of the Regents.  The decision of the Regents will be final.

 

COURSE ETHICS

Each student will be required to prepare written assignments and take written examinations as a part of this course.  Students should be absolutely aware of the instructor’s policies relative to the ethics regarding plagiarism and any other unethical student conduct that may occur relative to a scored activity.

PLAGIARISM is the theft of another person’s work or thinking.  Words as well as ideas are intellectual property and can be stolen from another person as easily as money or property.  As such, plagiarism can be a violation of criminal law. Copying the published work of another person is illegal without the express permission of that person (e.g. internet and journal articles). Portions of a published work may be quoted provided the quote is properly cited. Even in those cases where the law may not be technically violated, plagiarism is unethical.  Frankly, it is simply the wrong thing to do. In this course, it is also considered plagiarism to copy the work of another student. No studentmay COPY ANOTHER STUDENT’S WORK on any assignment for credit even if permission is given.

Unethical conduct during a quiz or examination is also simply the wrong thing to do. To say the least, for a student pursuing a health-related career, unethical conduct may be considered a reliable predictor of unacceptable job performance in the medical environment. If a student makes a choice to “cheat” on a test, will that student also make similar choices relative to accurate patient care? This instructor takes the position that a dishonest student in the classroom may indeed pose a threat to the safety of any patient who comes into contact with that student.  Healthcare employers take a similar position. The health care industry and Amarillo College will not tolerate this type of unprofessionalism.       

At Amarillo College, there are grave academic penalties for any unethical conduct on the part of any student. The policy and penalty for such conduct is provided in the “General Catalog” as follows:

“A high standard of conduct is expected of all students.  It is assumed that obedience to the law, respect for properly constituted authority, personal honor, integrity and common sense will guide the actions of each member of the college community both in and out of the classroom.  Any student who fails to perform according to expected standards may be disciplined.”

One should conclude from this statement that unethical course conduct is absolutely unacceptable by Amarillo College policy.  To be more specific, in this course, plagiarism, dishonesty, or any other unethical course conduct, is cause, at the minimum, for a final course grade of “F” regardless of other grades earned to-date in the course.  At the maximum, it may be cause to request the college administration to dismiss the student from the sonography program and Amarillo College.

WARNING!  This ethics policy is STRICTLY enforced!

This instructor practices zero-tolerance and “takes no prisoners” in any matter related to a course ethics violation.  A student should not risk earning a failing grade in this course, and possibly any future enrollment privileges at Amarillo College, as the result of any unethical behavior.

Grading Criteria

 The course will consist of several major examinations, assignments, a final comprehensive examination, and a lab final. Major examinations will be announced about one week in advance. Assignments are announced one lecture period in advance. Any bonus activity will NOT be announced in advance and CANNOT be made up if the student is absent, regardless of circumstances.

The final course grade will be computed as follows:

1.         All major examination results (total points) will be averaged and the average will count 30% of the final course grade.
2.        All quizzes, homework, and lab assignments will count for 20% of the final course grade. (Mandatory scans have to be completed each week. If a student is unable to complete all required (complete) scans by the end of the week, a grade of 0 will be recorded for that weekly lab grade). 
3.        The final course examination will be comprehensive (covers the entire course) and will  count 25% of the final course grade.
4.        The final lab practical will count for 25% of the final course grade.

The following grade scale applies throughout this course:

A = 92 - 100

B = 83 - 91

C = 75 - 82

F = less than 75

               Note:  A grade of "D" is not possible in this course

 

Decimal scores from all graded activities will be rounded as follows:

0.1 - 0.4            —         rounded down

0.5 - 0.9            —         rounded up

 

The final course average will be rounded in the same way.

Extra-credit work is NOT AVAILABLE in this course.  Under very special circumstances, it may be necessary for the course instructor to issue a final course grade of “incomplete” to provide additional time for the student to satisfactorily complete the course.  Such circumstances are rare and must be approved by the instructor.

When a final grade of “incomplete” is appropriate, a written contract to remove the “I” will be prepared by the course instructor and signed by the instructor and student. Normally, the grade of “I” must be converted to a passing grade within 90 days of the conclusion of the course. 

Under a very rare circumstance, a time extension of an additional 90 days is possible.  Each case will be handled on an individual basis and no one case shall set a precedent for another case.  If the “I” is not removed in accordance with the contract, the final course grade will be recorded as an “F”.

 

 

Attendance

Regular and punctual attendance is necessary for satisfactory achievement. It is the responsibility of the student to attend class. Class attendance will be recorded at each session. Only students that are present in class at the time an exam, quiz, or in class assignment is given will be allowed to participate. If the student is absent for one of these activities, they will receive a grade of zero for that assignment. Quizzes and in-class assignments can not be made up. In the case of a true emergency, and with advance notification to the instructor, arrangements for Unit Exams may be made at the instructor’s discretion and on a case by case basis.

All assignments will have a due date. It is expected the work be turned in at least by that time. I do not accept late work. If the assignment is not turned in by the due date, a grade of zero will be assigned.

Tardy’s count the same as an absence.  An absence is being more than 5 minutes late to class, or leaving more than 5 minutes early from class.

The door will be closed and locked at the beginning of class. If you are not in the classroom at this time you will not allowed to enter for lecture that day and will receive an absence for the day.

If a student has 2 absences or more, described in the text above, they will receive a 10% deduction from their final grade.

MAKE-UP POLICY
If a student is absent on the day of a major exam,  the work will be graded as follows:
1.    In order to be fair to students who take scheduled exams at the designated time, makeup exams will lose 15% of the original value.
2.    Major exams must be made up within one school day.
3.    NOTE:  Other arrangements may be made with instructor’s permission on a case-by-case basis.  It is the sole responsibility of the student to communicate the need for other options regarding make-up policies. The student should not wait until after a failed test to inform instructor of extenuating circumstances.

If a missed scored activity is not completed in accordance with this make-up policy, the specific activity in question will be scored as ZERO points and averaged as zero credit into the final course grade. This make-up policy is strictly enforced.

Calendar

Additional Information

Electronic devices which produce audible sounds must be silenced during all lecture presentations.  Also, text messaging during class and lab is absolutely prohibited.  You will be asked to leave the classroom, and won’t be able to return for that class period, if on phone.

 

STUDY TIPS FOR ACADEMIC SUCCESS

This course is very technical and, as such, demands strong student study skills to complete the course satisfactorily. Sonography is NOT “rocket-science,” but it does require persistent and effective study to grasp and retain the information.The following study skill guidelines have been tested through many years, and when used consistently, have been proven to work. Of course, students have different learning styles. Therefore, all skills listed may not be appropriate for you. If you have already developed a study system that works, don’t change it!   If that is not the case, the you should give strong consideration to the adoption of one or more of these guidelines.

1.       Plan to study no less than two clock-hours each week for each hour of class time. If you are academically challenged you should spend even more time. Class time is used to collect notes — NOT to learn the greater part of the information.  Effective learning must continue to take place outside of the classroom.

2.       NEVER extend a study session beyond 30 minutes without taking a short break.  For most students, continuous studying without frequent short breaks generally serves little or no useful purpose. It is not usually possible for the average student to remain sufficiently focused beyond 30 minutes.

3.       During a study session, get active! Choose an area free of distractions and don’t get comfortable. Read your notes and the textbook out loud if the location permits. Using the additional sense of hearing further improves retention and learning.  Reading silently using only the sense of sight and limits learning ability. 

4.       Re-write your lecture notes within twelve hours. Notes taken during a lecture session must often be abbreviated to save time. This creates gaps in sentence and paragraph structure. Therefore, if a re-write does not occur relatively soon, gaps will be difficult to close later. Also, a re-write involves the sense of touch which improves retention and learning. When closing gaps, be sure to consult the textbook for additional information relative to the subject under study. A good dictionary can also be helpful.

5.       Study with a classmate when possible.  For most students, group study reinforces learning.

6.       NEVER “cram” for tests. Cramming may work, but any success is only temporary since this study technique involves short-term memory. Use of long-term memory is absolutely necessary to successfully complete any course which requires a comprehensive final examination and a program of study where an overall program exit comprehensive examination and certification examination is also required. Instead of relying on a “crisis approach” to learning, stay organized and review often.

7.       Ask questions during class sessions and/or visit with the course instructor outside of class to clarify information that may be difficult for you to grasp. If necessary, seek advice from the instructor for making improvements. However, seeking advice during the final couple of weeks of the course is probably too late!

8.       Avoid, at all cost, a pessimistic attitude. Instead, THINK POSITIVELY! A person in very likely to mentally move in the direction he or she thinks about most often. When a subject seems overwhelming, don’t panic!  When the brain is in “panic mode,” it cannot simultaneously be in an effective learning mode. If panic develops, STOP!  Re-evaluate your study skills and make immediate changes that can remove or reduce the difficulty. Chances are, the panic is the result of not enough time set aside to learn the information.

9.       Improve your self-confidence! An excellent online tool to help build self-confidence can be seen at …

                                                http://www.mindtools.com/selfconf.html