Allied Health 124
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DMSO-2353-001 Sonography of Superficial Structures
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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(3 sem hrs; 3 lec)
On Campus Course
Textbook of Diagnostic Sonography, 8th Edition, Hagen-Ansert
Textbook of Diagnostic Sonography, 8th Edition, Hagen-Ansert Workbook
Ultrasound Scanning, Principles and Protocols, 3rd Edition, Betty Bates/Tempkin
Laptop with webcam, notebooks, pens, pencils, page protectors
Given the course textbook, personal notes, handouts, and other course materials, the student should accomplish the following course goals as evaluated by the course instructor using written exams and methods, oral presentations, visual presentations and teaching opportunities with class mates:
Describe breast anatomy and sonographic layers and landmarks
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
Identify normal and abnormal thyroid structures sonographically
Understand the lab findings in neck pathology
Understand thyroid biopsies
Perform protocols for breast, thyroid, MSK, testicles and infant hip
Understand land marks and techniques for scanning an infant hip
Be able to identify and differentiate muscles, tendons, nerves and vascular structures
Be able to identify qualities of a thyroid malignancy
Understand normal testicle anatomy
Know the pathology associated with the testicle
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)
Boundaries, Areolar Area, Internal Nipple, Subcutaneous Fat, Cooper's Ligaments, Mammary/Glandular Tissue
Glandular, Fatty, Fibrous, Involution, Pregnancy
Internal Mammary and Anterior Perforating Branches, Lateral Thoracic Arteries, Venous Drainage, Superficial Veins
Flow and Route of Lymph, Axillary Lymph Node Dissection
Normal Anatomy, Gynecomastia
Physiology of Breast
Primary Function, Ductal System, Milk Production
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
Positioning, Scanning Technique, Annotation
Sonographic Characteristic of Breast Masses
Margins, Disruption of Breast Architecture, Shape, Orientation, Internal Echo Pattern, Attenuation Effects, Mobility, Compressibility, Vascularity
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:
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
Anterior, Posterior, Medial
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.
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)
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
Expected Student Behavior:
Courtesy and respect are expected among students and the instructor. Students are expected to be attentive to instructor and guests at all times and during presentations of other students. Students are to extend the highest respect to patients/clients/others when making off campus contact. Lack of regard to this expectation at any time by any single student or group of students may result in immediate dismissal from the classroom.
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.
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 student may 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:
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!
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.
GRADING CRITERIA AND SCALE
The final course grade will be computed as follows:
Tests and Final= 40%
Quizzes = 20%
Case studies= 20%
Late assignments will be given a 10 point deduction one day after the due date, 25 on day 2, 50 point deduction on day 3. A zero will be given on anything later than 3 days.
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”.
Tutoring is available and mandatory for any assignment grade below 75%.
Due to classes only meeting once per week attendance is critical to your success. Students are expected to attend each class session, take quizzes, tests and the final exam on the scheduled dates unless an excused absence is obtained. This absence must be reported before class on the day of the absence.
Excused absences are:
(1) Extreme illness involving student or his/her immediate family (spouse, child, parent, grandparent or sibling)
(2) Death in the student's immediate family.
Any absence other than listed above is considered unexcused.
If you miss a class you are responsible for all announcements, subject matter, and assignments for each class.
Only one absence is allowed per summer session. After the first absence, the student will be docked 10% from his/her final point total for the course.
Students may not take more than one makeup quizzes and/or tests per course. Make-up quizzes/exams are only given if the instructor is notified prior to class time, and the absence is excused.
If you need to makeup a quiz/exam you must schedule to make up the exam before the next class day back or a grade of “0” will be recorded for the missed quiz/exam.
Quizzes and/or exams may not be taken early in any class. .
On a rare occasion, a student may know in advance of an impending and UNAVOIDABLE absence. If that absence is to occur on a day when a scored activity is to be taken, the student may petition the instructor, IN ADVANCE (1 week minimum) AND IN WRITING, for an “excused absence.” Each excused absence request will be handled on an individual basis and the decision of the instructor will be final. If approved by the instructor, an excused absence will not result in the loss of any points on the scored activity due to the absence, however, it will still count toward your absences for the semester.
Students not turning assignments in on time due to absence must turn the assignment in on the first day back to class, the student will lose 5 points for every day it is late.
Classroom/Laboratory Tardiness and/or Leaving Early
Punctual attendance is expected for all class sessions. 3 tardies and/or leaving early will count as an absence. Any material missed will be the responsibility of the student to obtain from fellow students. Each tardy or early dismissal after the 3 will deduct 1% from the final overall grade for each occurrence.
Week 1 Breast
Week 2 Thyroid
Week 3 Test: MSK
Week 4 Scrotum
Week 5 Infant Hip
Week 6 Final
Electronic devices which produce audible sounds must be silenced during all lecture presentations. Also, text messaging during class and lab is absolutely prohibited. Recording or filming of lectures is not allowed unless permission is granted before class.
All cell phones and smart watches must be placed in your bags at front of the room during any and all quizzes and tests.
Respondus lockdown browser will be used for all exams. Please make sure that it is downloaded prior to testing.
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 …
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