Ultrasound Challenge
2013 Handbook
Ultrasound Academy
College of Medicine/Department of Emergency Medicine
The Ohio State University
1
Table of Contents
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
Introduction....................................................................................................... 3
Fundamental principles of the Ultrasound Challenge....................................... 3
Participant information ..................................................................................... 3
Event rules ......................................................................................................... 5
A. FAST ...................................................................................................... 5
B. Cardiac .................................................................................................. 5
C. Aorta ..................................................................................................... 5
D. Pelvic .................................................................................................... 5
E. Vascular Access .................................................................................... 6
F. Carpal Tunnel Self-Scan ........................................................................ 6
Proctor information........................................................................................... 6
Trained Simulated Ultrasound Patient information .......................................... 8
Scoring ............................................................................................................... 8
A. Single event scoring: Cardiac, FAST, Pelvic, Aorta, Self-Scan ............... 8
B. Single event scoring: Vascular Access .................................................. 8
C. Image guidelines................................................................................... 9
C1. Identification/Orientation .......................................................... 12
C2. Technical skills ............................................................................ 18
C3. Resolution and image quality ..................................................... 28
D. Sonographer’s Cup scoring ................................................................... 38
E. Additional prizes ................................................................................... 38
F. Spectator events................................................................................... 38
Participant fact sheet ........................................................................................ 39
Library of sample scans and images .................................................................. 40
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I. Introduction.
The Ultrasound Challenge (formerly known as the Ultrasound Olympics) was conceived in 2009 by
David Bahner MD, RDMS and fourth year medical students Matthew Dell’Aquila and Justin Dzik at
The Ohio State University. The inaugural competition took place in February 2010 and consisted of
four individual events as part of a larger competition. Its success as an educational outlet as well as
a paradigm of ultrasound sportsmanship prompted the formation of this charter.
II. Fundamental principles of the Ultrasound Challenge.
1. Ultrasound education has become an increasingly important component of the curriculum at
many U.S. medical schools. The advance of technology often outpaces the rate at which an
institutional program can evolve. It is therefore crucial to offer medical students the
opportunity to demonstrate their abilities to use this valuable diagnostic imaging modality.
2. By introducing competition and sportsmanship to aspiring sonographers, medical students are
given incentive for practicing and perfecting their ability to acquire high quality images using
modern ultrasound machines.
3. The Ultrasound Challenge is a focused, organized, and enduring movement. It is inspired by
students who value the use of bedside ultrasonography in medical education and realize its
expedient, cost-effective diagnostic utility to practicing physicians.
4. Every qualifying individual will be given the opportunity to compete in the Ultrasound Challenge.
To deny any student participation is contrary to the spirit of the competition.
III. Participant information.
1. Participants should familiarize themselves with scans on EMSONO. Access to this resource is
available from all computers within the medical center at The Ohio State University and can be
accessed off-campus via the Prior Health Sciences Library website, http://hsl.osu.edu. All Ohio
State participants must complete the Practical Scanning Module on EMSono prior to the event.
2. All participants must sign-up for events prior to the Ultrasound Challenge weekend. All
participants will be required to contact the Ultrasound Challenge scheduling coordinator by
email to indicate which event(s) that participant would like to take part in.
3. All participants must complete a “Fact Sheet” prior to the event and email it to the coordinator
for use by the commentators on the day of the event. See appendix 1 for the complete Fact
Sheet.
4. Participants should review how scans will be scored. The rubric for scoring varies slightly for
different events based on the features most pertinent to each specific ultrasound examination.
See section VII for detailed information on scoring.
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5. Practice sessions can be organized in The Ohio State University College of Medicine’s Clinical
Skills lab using the online clinical skills lab request form. All contestants are strongly encouraged
to have at least five practice scans logged for the event(s) in which they are participating.
Practice sessions will be sponsored by the Ultrasound Interest Group near the date of the event.
Students in the Honors Ultrasound fourth year elective will also offer opportunities for
participants to refine their ultrasound skills.
Students from other institutions participating in the Ultrasound Challenge are encouraged to
organize and participate at practice sessions held by their institution.
6. The Ultrasound Challenge will be held Saturday, March 2, 2013. Any student currently enrolled
at The Ohio State University College of Medicine may participate in any number of the official
Ultrasound Challenge Events. Each event will consist of one scan per participant; images from
these scans will be saved and reviewed later to determine the top scorers and winners in each
event.
7. The six events are as follows:
a. FAST
b. Aorta
c. Cardiac
d. Pelvic
e. Vascular Access
f. Carpal Tunnel Self-Scan
8. The Sonographer’s Cup will be awarded to the participant with the greatest number of
Sonographer’s Cup points. Points will be awarded in the manner described in section VII.
9. Judge qualifications will be determined by event facilitators. Attending physicians are
encouraged to volunteer as judges for the fourth annual Ultrasound Challenge.
10. Each participant must arrive at least 30 minutes before the start of their scheduled scanning
session. Approximately 10 minutes before each scheduled session, all participants will be taken
into the locked Clinical Skills Center; participants arriving after this will not be allowed to scan.
The scheduling coordinator will assign participants to events in such a way that each participant
can compete in all events if they so choose.
11. At each event station, contestants will be required to independently enter an identifying code
into the ultrasound machine prior to scanning. Judges will be blinded to these codes when
images are scored. Contestants will refer to rules (section IV) for each event to learn which
images must be captured. Scoring rubrics will be provided to all participants at each event.
Models are not permitted to help identify anatomic structures or offer advice on how to acquire
ideal images.
12. Aorta scan and Cardiac scan stations will be staffed with a single model for the duration of each
round for continuity. Models may respond to contestant requests for position change, but may
not offer advice or help of any kind with the contestant’s performance.
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13. Participants are required to save appropriate images during scanning. Judges will score
participants based on image quality following the completion of all events. Judges will review
stored images to determine a participant’s overall score in an event.
14. Time for each event will be kept by the models/proctors at each station. Time will begin
immediately when the master timekeeper indicates that scanning may begin. Time will
conclude when the Olympian captures his or her final image AND vocalizes “time” to the judge.
A maximum of twelve minutes are allowed for the FAST and Pelvic scans. A maximum of eight
minutes are allowed for the Cardiac and Aorta scans. A maximum of five minutes are allowed
for Carpal Tunnel Self-Scan and Vascular Access.
IV. Event rules.
A. FAST
The FAST exam consists of 4 views: the cardiac subxiphoid view, the perihepatic view, the
perisplenic view, and the long axis view of the bladder. The objective of the FAST is to
assess for free fluid around the heart, in the abdomen, and in the pelvis.
 Subxiphoid: Image of the heart with identification of the four heart chambers.
 Perihepatic: Image and identification of the liver and right kidney.
 Perisplenic: Image and identification of the spleen and left kidney.
 Pelvic: Image and identification of the bladder.
B. Cardiac
The cardiac exam for the purposes of this competition consists of 2 views: the parasternal
long axis view and the parasternal short axis view at the heart base. Cardiac ultrasound
exams focus on the dynamics of heart function.
 Parasternal Long Axis: Image of the heart in long axis with identification of the left
atrium, left ventricle, and right ventricle.
 Parasternal Short Axis: Image of the heart in short axis with identification of the left
ventricle and right ventricle and either mitral valve OR papillary muscles.
C. Aorta
The aorta exam consists of 3 views: the celiac trunk, the superior mesenteric artery (SMA)
view, and the aortic bifurcation in short axis.
 Celiac Trunk: Image of the aorta where the celiac axis branches with identification
of the celiac trunk, vertebral body, aorta, and IVC.
 SMA: Image of the aorta visualizing the SMA with identification of the SMA,
vertebral body, IVC, and aorta.
 Bifurcation: image of the aorta at the level of bifurcation into the left and right
common iliac arteries with identification of each.
D. Pelvic
Accomplished using a phantom nicknamed “Lulu,” pelvic ultrasound focuses on the
identification of the female genitourinary system. The exam consists of 5 views: sagittal
view of uterus/cervix, coronal view of uterus, estimated gestational age, left ovary, and right
ovary.
5





Sagittal view of Uterus/Cervix: A sagittal image of the uterus with identification of
the cervix and endometrial stripe.
Coronal view of Uterus: A coronal image of the uterus with identification of the
endometrial stripe.
Estimated gestational age: A sagittal image of the uterus with identification of the
embryo. The age of this embryo must be estimated using the “Crown-Rump
Length” calculator feature.
Left Ovary: Dual screen image of LEFT ovary measuring the volume of entire ovary.
Ovary, side (right vs. left), and cyst must be identified on this image.
Right Ovary: Dual screen image of RIGHT ovary measuring the volume of entire
ovary. Ovary, side (right vs. left), and cyst must be identified on this image.
E. Vascular Access
Venous cannulation utilizing ultrasound is quickly becoming the standard of care for central
line placement in medical centers throughout the country. The objective of this exam is to
demonstrate correct technique for performing ultrasound-guided vascular access. Prior to
performing the procedure, participants must visualize the vessel in the long axis, sweep the
vessel in the short axis, and view the “North Star” sign (where the needle presented just
under the skin, vessel, and probe are all in alignment). Participants must also maintain
constant pressure on the syringe and use a short jab to penetrate the vessel. Proper
scanning techniques including contact with the patient and use of appropriate motions are
important to this competition as well. For full scoring details, see section VII.
F. Carpal Tunnel Self-Scan
Self-scanning is a mark of ingenuity on the part of the participant. In this event, the
participant scans his or her own forearm proximal to the wrist to view the carpal tunnel.
The proctor will assist the participant by freezing the image on command, however
participant must take all other steps to obtain the image and label it appropriately.
Median Nerve: Image of carpal tunnel with identification of the median nerve, flexor
digitorum profundus, and flexor digitorum superficialis.
V. Proctor information.
1. Before the start of every exam:
Ensure that “End Exam has been selected under the Patient toolbar on the ultrasound machine.
Ensure that the models for FAST, cardiac, and aorta are free of gel prior to beginning each exam.
2. Each proctor is given a script that must be read to each contestant at the start of each
ultrasound examination. The script explains the expectations of the exam as well as the rules
and regulations of the competition.
Proctor Scripts - 2013 Ultrasound Challenge
Hello and thank you for participating in the Ultrasound Challenge today. My name is (name) and I
will serve as your (model, proctor) for your timed (exam). You will sign-in using your provided ID
number to save images. Once the master timekeeper indicates “begin,” we will start the clock and
you may begin scanning. You are not allowed to add gel to either the patient or to the probe until
time has started. I will stop the time once you state “done” and have completed all the items on the
checklist for your exam. You have a maximum of (five, eight, twelve) minutes.
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FAST
For the Fast exam, you are not allowed to ask the model or proctors for assistance during the exam
unless there is a malfunction with the ultrasound machine.
You may not ask the model or proctors any questions regarding labeling of structures. You may not
take the image checklist sheet with you to the scanning area.
You will be allowed to ask your model to adjust his or her body as YOU see fit during the exam. You
may not ask your model for tips on viewing his or her anatomy.
There is no particular order in which you are to complete the four views that comprise the FAST.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
Aorta
For the Aorta exam, you are not allowed to ask the model or proctors for assistance during the exam
unless there is a malfunction with the ultrasound machine.
You may not ask the model or proctors any questions regarding labeling of structures. You may not
take the image checklist sheet with you to the scanning area.
You will be allowed to ask your model to adjust his or her body as YOU see fit during the exam. You
may not ask your model for tips on viewing his or her anatomy.
There is no particular order in which you are to complete the three views that comprise the aorta
exam.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
Cardiac
For the Cardiac exam, you are not allowed to ask the model or proctors for assistance during the
exam unless there is a malfunction with the ultrasound machine.
You may not ask the model or proctors any questions regarding labeling of structures. You may not
take the image checklist sheet with you to the scanning area.
You will be allowed to ask your model to adjust his or her body as YOU see fit during the exam. You
may not ask your model for tips on viewing his or her anatomy.
There is no particular order in which you are to complete the two views that comprise the cardiac
exam.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
Pelvic
For the Pelvic exam, you are not allowed to ask the proctors for assistance during the exam unless
there is a malfunction with the ultrasound machine.
You may not ask the proctors any questions regarding labeling of structures. Estimated gestational
age is to be measured in crown-rump length (CRL). You may NOT take the image checklist sheet
with you to the scanning area.
There is no particular order in which you are to complete the five views that comprise the pelvic
exam.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
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Vascular Access
For the Vascular Access exam, you are not allowed to ask the proctors for assistance during the
exam unless there is a malfunction with the ultrasound machine.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
Carpal Tunnel Self-Scan
For the Median Nerve self scan, you will not be assisted in obtaining images by the event proctors.
At any time, you may request that images be frozen on the ultrasound machine. You may not ask
the proctors any questions regarding labeling of structures.
You may not take the image checklist sheet with you to the scanning area.
You will be given warnings when two minutes remain and when thirty seconds remain. When time
is called, you must stop scanning and put down the probe immediately.
VI. Trained Simulated Ultrasound Patient information.
1. Models for the Ultrasound Challenge will be recruited from the active pool of Trained Simulated
Ultrasound Patients. Every attempt will be made to recruit models with ideal anatomy.
2. Models are asked to drink 1 liter of water 30 minutes prior to the start of the first session to
allow for optimal acoustic windows. FAST and Aorta models are also asked to refrain from
carbonated beverages and chewing gum for the duration of the competition.
3. On the day of the competition models will be asked to complete a “TSUP Information Sheet”
containing various information such as estimated BMI, time of last meal, and known difficulties
with the models’ personal acoustic windows.
VII. Scoring.
A – Single Event Scoring: Cardiac, FAST, Pelvic, Aorta, Self-Scan
1. Each contestant will be given a “quality score” for their images in each event. The image quality
scoring guidelines have been modified from the B-QUIET model of image grading developed at
The Ohio State University. All scores are awarded at the discretion of the event judges.
2. Medals and prizes will be awarded to the first, second and third place finishers of each event.
3. All ties will be broken using the fastest time between participants with the same score.
B – Single Event Scoring: Vascular Access
1. Each contestant will be scored on scanning and procedural technique. All scores are awarded at
the discretion of the event judges.
2. Medals and prizes will be awarded to the first, second and third place finishers of each event.
3. Scoring rubric:
a. Procedural Technique: Visualize True Long Axis – 1 point, Broad Sweep Prior to Access – 1
point, “North Star” Sign – 1 point, “Leap Frog” Technique – 1 point, Jab to Penetrate Vessel – 1
point, Constant Negative Pressure on Syringe – 1 point. 6 points total.
b. Scanning Technique: Contact with “Patient” – 1 point, Probe Held Appropriately – 1 point,
Appropriate Motions – 1 point, Efficiency/Time – 1 point. 4 points total.
4. All ties will be broken using the fastest time between participants with the same score.
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C – Image Guidelines
For each event, an image score sheet (modified from the validated B-QUIET criteria) similar to the
one below will be used to score image quality (see next page).
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B QUIET
Brightness mode Quality Ultrasound Imaging Examination Technique
1. Identification/Orientation
1.0
Date/Time (Machine Default)
1.1 Patient Name/MRN/Sonographer
1
2
3
4
1.2 Body Marker
1
2
3
4
1.3 Comments (Image Title, Labeled structures)
1
2
3
4
2.1 Resolution-- Application/Focal Zone
1
2
3
4
2.2 Depth -- Field of view
1
2
3
4
2.3 Gain (Segmental, Overall)
1
2
3
4
2. Technical
___________________________________________________________________
3. Image Anatomy
3.1
Near Field (Top of Screen)
1
2
3
4
3.2
Receding Edge (Right Side)
1
2
3
4
3.3
Far Field (Bottom of Screen)
1
2
3
4
3.4
Leading Edge (Left Side)
1
2
3
4
___________________________________________________________________
Total
______________________
1: Unacceptable
2: Needs Improvement
3: Acceptable
4: Optimal
Exam Difficulty
1
2
1= Difficult Exam (poor windows, inappropriate preparation)
2= Challenging exam
3= Acceptable exam
4= Optimal exam (Good windows, clear anatomy)
10
3
4
Likert Standard Scoring Explanatory Numeric
Identification/ Orientation
1.1 Identification 1 = All absent 2 = One present, one accurate
3 = Two present, two accurate 4 = All present, all accurate (Sign the image)
1.2 Body Marker 1 = Absent
2 = Wrong marker, wrong probe position
3 = Correct marker, wrong probe position 4 = Correct marker, correct probe position
1.3 Comments 1 = No comments 2 = Title present, inaccurate or no
labels 3 = Image title + minimal labels (1-2 structures) 4 = Title + multiple labels (>2)
Technical
2.1 Resolution 1 = Wrong application, wrong focal zone 2 = Correct application, wrong focal zone
3 = Wrong application, correct focal zone 4 = Correct application, correct focal zone
2.2 Depth 1 = Image too small (<half of screen) 2 = Image cut off or not maximized at present depth
(>4 cm from ideal depth) 3 = Adequate depth (within 1 –3 cm) 4 = Optimal depth
(Intended image fills the screen)
2.3 Gain 1 = Inappropriate (too white, too dark throughout the image) 2 = Poor gain setting in near
or far field 3 = Adequate gain settings (Minimal echoes in fluid filled structures, all structures
contrasted) 4 = Optimal gain settings and grayscale (No internal echoes in vascular or fluid
filled structures, appropriate tones to soft tissue)
Anatomy
3.1 Near field 1 = Unclear representation
2 = Image partially distorted
3 = Adequate visualized anatomy 4 = Optimal near field anatomy representation
3.2 Receding edge (Right side image ) 1 = Unclear representation 2 = Image partially distorted 3 =
Adequate visualized anatomy 4 =Optimal anatomy representation
3.3 Far field 1 = Unclear representation 2 = Image partially distorted
3 = Adequate visualized anatomy 4 = Optimal far field anatomy representation
3.4 Leading edge ( Left side image) 1 = Unclear representation 2 = Image partially distorted 3 =
Adequate visualized anatomy 4 = Optimal anatomy representation
Copyright @ 2000 The Ohio State University, all rights reserved
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C1 – Identification/Orientation
1) Patient Name/MRN/Sonographer (0,7): Prior to beginning a scan, the participant must enter their
medical center ID (Name##) into the “Patient” field on the ultrasound machine. This helps the judges
track the images and is standard practice. (A phantom scan is no scan!) This line should be an easy seven
points for all participants.
2) Body Marker OR Image Identifier (0,3,5,7): Body markers and image identifiers note where on the
body a view was obtained. Body markers have four distinct scores: 0 – no body marker OR image
identifier, 3 – grossly incorrect body marker or image identifier, 5 – minor error with body marker or
image identifier, 7 – correct body marker or image identifier. As above, this line should be an easy seven
points for all participants.
3) Image Labels (0-7): Labeling is important. Labels help other practitioners review images long after
they have been obtained and forgotten about. This category is scored on a continuum from 0-7 at the
judges’ discretion; however, guidelines for scoring this area are as follows: 0 – no labels, 1,2 – grossly
incorrect labels, 3,4 – correct but insufficient labels, 5,6 – minor errors in labeling, 7 – correct labels.
4) Examples:
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1.2 Body Marker OR Image Identifier
0
1.3 Image Labels
0 1
3
2
3
5
4
5
7
6
7
The above image uses no labels and no body marker or image identifier. It receives zero points for each
of these categories.
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1.2 Body Marker OR Image Identifier
0
1.3 Image Labels
0
3
1
2
3
5
4
5
7
6
7
The above image would be excellent…if that were actually the liver! This image is mislabeled with both
the body marker and the labels, representing the right side of the patient while the left side of the
patient is actually shown. This image receives a 3 for improper body marker and a 2 for grossly incorrect
labels.
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1.2 Body Marker OR Image Identifier
0
1.3 Image Labels
0
3
1
2
3
5
4
5
7
6
7
This image has a proper body marker and receives 7 points under that category; however, the labels,
while correct, are inappropriately placed. The goal when labeling is to accentuate your image, not
obscure it. This image receives a 5 for labels for minor error in placement.
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1.2 Body Marker OR Image Identifier
0
1.3 Image Labels
0
3
1
2
3
5
4
5
7
6
7
This image is appropriately labeled with a body marker and organ labels. It receives 7 points in each
category.
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1.2 Body Marker OR Image Identifier
0
1.3 Image Labels
0
3
1
2
3
5
4
5
7
6
7
Note that image identifiers are also acceptable in the place of body markers. “Hepatorenal” in the upper
corner appropriately identifies where this image was obtained from.
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C2 – Technical Skills
1) Contact Quality (0-7): This area notes if contact artifacts (from lack of pressure or gel) are present and
to what extent they affect image quality. Guidelines for scoring are as follows: 0 is awarded for contact
artifacts significant enough to obscure the entire image, 2 is awarded for significant contact artifacts
affecting image quality, 5 is awarded for significant contact artifacts not affecting image quality, and 7 is
awarded for no contact artifacts. Scoring along this continuum is at the judges’ discretion.
2) Depth (0-7): This line scores the depth used for each scan. Scoring along this continuum is at the
judges’ discretion. Guidelines for scoring are as follows: 7 is awarded for ideal depth, and points are
subtracted for levels of decreasing image quality due to non-ideal depths. Images so shallow that the
organ of interest is barely visible are awarded a 2. To score a 0 in this category requires spectacular
effort. Most scores should range from 5-7.
3) Gain (0-7): This category scores the gain used for each scan. Scoring along this continuum is at the
judges’ discretion. Guidelines for scoring are as follows: 7 is awarded for ideal gain, and points are
subtracted for levels of decreasing image quality due to non-ideal gain. The goal in ultrasound is to use
gain to enhance the image, not wash it out. As above, most scores in this category should range from 57.
4) Examples:
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2.1 Contact Quality (Artifact Prevention)
0
1
2
3
4
5
6
7
The contact artifact in this image from lack of gel/pressure is significant enough to obscure the image. It
receives a 2 for contact quality.
19
2.1 Contact Quality (Artifact Prevention)
0
1
2
3
4
5
6
7
The contact artifact in this image is minimal to moderate and does not significantly affect the organ
being investigated. This image is awarded a 6 for contact quality.
20
2.1 Contact Quality (Artifact Prevention)
0
1
2
3
4
5
6
7
This image has no noted contact artifact and receives a 7 for Contact Quality.
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2.2 Depth -- Field of view
0
1
2
3
4
5
6
7
This image is so shallow that it obscures the lower border of the heart. Very little of the left atrium is
visible, and the pericardium cannot be seen, making this image useless as a rescue view looking for
pericardial free fluid. Some important components can be seen in this image, but the depth is
catastrophically shallow. This image is awarded a 2 for depth.
22
2.2 Depth -- Field of view
0
1
2
3
4
5
6
7
This image, while better than the previous one, is still not entirely clear. This image is so deep that the
organ in question is small; as a result, pathology would be more difficult to identify on this as compared
to the same image with more appropriate depth set. This image is awarded a 5 for depth.
23
2.2 Depth -- Field of view
0
1
2
3
4
5
6
7
This is a good image with regards to depth. It is not so shallow that areas of interest are lost, nor is it so
deep that the heart is excessively small on the screen. This image is awarded a 7 for depth.
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2.3 Gain
0
1
2
3
4
5
6
7
This image is so dark that it washes out the salient features of the parasternal short axis view of the
heart. Because of the detrimental effect on image quality, this image is awarded a 2 for gain.
25
2.3 Gain
0
1
2
3
4
5
6
7
This image has the gain so high that not even the areas that are supposed to appear anechoic (inside the
ventricles) are black. The anatomy in question is visible, however. This image was awarded a 5 for gain.
26
2.3 Gain
0
1
2
3
4
5
6
7
This image is appropriately calibrated with regards to gain. Anechoic areas (the ventricles) appear black,
tissues appear isoechoic, and all appropriate structures are identifiable and shaded nicely. This image
was awarded a 7 for gain.
27
C3 – Resolution and Image Quality
1) Near and Far Fields (0-7): This item grades the quality of the scan with regards to the near field.
Several miscellaneous artifacts (rib shadows, bowel gas, etc) can obscure the near field of an image; this
category scores the near field of the scan with regards to clarity and freedom from artifacts. Grading
along this continuum is at the judges’ discretion. Guidelines for scoring are as follows: 0 – Artifacts and
technique lead to a near or far field that is unrecognizable. 1-2 – Artifacts and technique greatly obscure
the near or far field with some anatomy visible. 3-4 – Artifacts and technique moderately obscure the
near or far field with most anatomy visible. 5-6 – Minor artifacts in the near or far field lead to some
quality issues that do not interfere with image interpretation. 7 – Near and far fields are clear and free
from artifacts.
2) Leading and Receding Edges (0-7): This category scores the quality of the scan with regards to the
edges of the field. As above, several miscellaneous artifacts (rib shadows, bowel gas, etc) can obscure
the leading and receding edges of an image; this category scores the edges of the scan with regards to
clarity and freedom from artifacts. 0 – Artifacts and technique lead to leading and receding edges that
are unrecognizable. 1-2 – Artifacts and technique greatly obscure the leading and receding edges with
some anatomy visible. 3-4 – Artifacts and technique moderately obscure the leading and receding edges
with most anatomy visible or the image is significantly off-center. 5-6 – Minor artifacts in the leading or
receding edges lead to some quality issues that do not interfere with image interpretation or the image
is modestly off-center. 7 – Leading and receding edges are clear, free from artifacts, and the image is
appropriately centered.
3) Overall Image Quality (0-7): This category scores the overall quality of each scan with respect to its
images. Scores are given based on overall clarity and success at demonstrating the anatomy required for
each scan. Scores are given at the judges’ discretion. Guidelines for scoring are as follows: 0 – No image.
1-2 – Image severely distorted by artifacts, poor technique, failure to use technology, or other problems.
3-4 – Image somewhat distorted by artifacts, poor technique, failure to use technology, or other
problems. 5-6 – Image relatively clear with mild problems concerning resolution or focus. 7 – Crystal
clear image with no deficits.
4) Examples:
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3.1 Near Field/Far Field (Top/Bottom of Screen)
0
1
2
3
4
5
6
7
This image has a lot of bowel gas artifact obscuring the near and far fields. Though bowel gas is a fact of
life in abdominal ultrasound, one of the challenges of being a sonographer is using appropriate
technique to minimize bowel gas effect on obtained images. Some useful structures are visible, but both
the Aorta and SMA are nearly completely obscured by artifact. This image is awarded a 2 for Near/Far
Field clarity.
29
3.1 Near Field/Far Field (Top/Bottom of Screen)
0
1
2
3
4
5
6
7
This image is significantly better than the previous one, but it is still not quite “right”. There are issues
with image clarity in the near and far fields; all required vessels are visible, but they aren’t sharp. The
image’s resolution is mildly decreased by bowel gas, but the operator has done a relatively good job of
minimizing the effect of this artifact on image quality. Overall, this image is awarded a 6 for Near/Far
Field clarity.
30
3.1 Near Field/Far Field (Top/Bottom of Screen)
0
1
2
3
4
5
6
7
This image effectively demonstrates all important characteristics of the Superior Mesenteric Artery at
the level of the Aorta. The “target sign” is seen just above the Aorta indicating the location of the
Superior Mesenteric Artery. The IVC is also visible and all relevant structures are clear and labeled in this
image, which receives a 7 for Near Field/Far Field clarity.
31
3.2 Leading/Receding Edge (Left/Right of Screen)
0
1
2
3
4
5
6
7
This image is an attempt to capture the Aorta at the level of the Celiac trunk. While the IVC and Aorta
are visible, the structures labeled as branches of the Celiac on the right side of the image (patient’s left)
are questionable at best, and could actually represent veins off the IVC. This image receives a 2 for
Leading/Receding Edge clarity.
32
3.2 Leading/Receding Edge (Left/Right of Screen)
0
1
2
3
4
5
6
7
This image has a great Celiac trunk (“seagull sign”), but it is significantly off-center. Furthermore, there is
some artifact obscuring the sides of the image and the IVC and Aorta are not well-visualized. Overall,
this image receives a 5 for Leading/Receding Edge clarity.
33
3.2 Leading/Receding Edge (Left/Right of Screen)
0
1
2
3
4
5
6
7
This image demonstrates the Abdominal Aorta at the level of the Celiac trunk. The IVC, Aorta, Vertebral
Body, and Celiac trunk (“seagull sign”) are all readily visible, centered, and appropriately labeled. This
image is awarded a 7 for Leading/Receding Edge clarity.
34
3.3 Overall Image Quality
0
1
2 3
4
5
6
7
Overall, this is a fairly poor image. This image has moderate problems with depth (too deep), it is slightly
too bright, and the structures in question are simply poorly visualized. This image could have been easily
improved with better technique; it is awarded a 3 for overall image quality.
35
3.3 Overall Image Quality
0
1
2
3
4
5
6
7
This image is fairly good, but has poor resolution and could likely be improved further. The important
structures are labeled and visualized appropriately. There is some shadowing between the two arteries
that obscures them somewhat. The image is slightly off center. For an image identifying a few small
objects in close proximity to one another, zoom is an excellent function to utilize and would have
drastically improved this image.
36
3.3 Overall Image Quality
0
1
2
3
4
5
6
7
This is an excellent image of the Aorta at the level of the bifurcation. The depth is appropriate for image
capture, the right and left common iliac arteries are distinct, appropriately anechoic, and appropriately
labeled. This image receives a 7 for overall image quality.
37
D – Sonographer’s Cup Scoring
1. Participants that compete in any event of the Ultrasound Challenge trials will automatically be
entered into the Sonographer’s Cup competition.
2. Using the scoring method described in the previous section, a contestant’s rank in each event
will translate into points for the Sonographer’s Cup competition.
(a) 1st Place = 10 points
(b) 2nd Place = 7 points
(c) 3rd Place = 5 points
(d) 4th Place = 3 points
(e) 5th Place = 2 points
(f) Participation = 1 point
3. The contestant with the highest point total will be awarded the Sonographer’s Cup. The winner
of the Cup will be immortalized in engraving on the Cup itself, which will proudly be displayed in
Meiling Hall. Prizes will also be awarded for the top three finishers in the overall Cup standings.
E – Additional Prizes
1. The three participants with the highest combined event score across all events from each nonsenior class (Med Year 1-3) will receive an additional prize.
2. The two participants with the highest combined event scores across all events among active
members of the Ultrasound Interest Group will be awarded prizes.
F – Spectator Events
1. Spectators will be encouraged to attend the Ultrasound Challenge Trials and Finals. A variety of
events will take place to promote participation as a spectator, with the overall goal of the
Ultrasound Challenge to increase awareness of ultrasound technology and education. Spectator
events will be held throughout the medical campus during the entire competition.
2. Ultrasound Events will be broadcast via streaming video through the world wide web for
spectators interested in ultrasound around the world. This stream will also be viewable from
within Meiling Hall throughout the competition.
3. A guest speaker will be invited to participate as a guest judge during the competition. The guest
will speak during lunch in Meiling Hall on the day of the competition. All participants, judges,
and spectators will be invited to attend. Food and drinks will be provided at this special event.
4. A panel of current medical students will be invited to speak to interested pre-medical students
regarding medical school and The Ohio State University College of Medicine. The purpose of the
panel is to both inform potential medical students about the benefits of medical education and
encourage participation by pre-medical students as spectators in the Ultrasound Challenge.
38
VIII. Participant fact sheet.
Ultrasound Challenge Participant Fact Sheet
Name:
Email:
Class Year:
Please underline the events you would like to register for.
FAST
Cardiac
Aorta
Pelvic
Vascular Access
Median N
Please underline the ultrasound activities you have been involved in.
Trinity
TSUP pool
US Basic
39
Honors US
USIG
X.
Library of sample scans and images.
FAST – Subxiphoid
FAST – Hepatorenal
40
FAST – Splenorenal
FAST – Pelvic
41
Cardiac – Parasternal Long Axis
Cardiac – Parasternal Short Axis
42
Aorta – Celiac Trunk
Aorta – Superior Mesenteric Artery
43
Aorta – Bifurcation
Pelvic – Sagittal View of Uterus
44
Pelvic – Dual Screen of Ovarian Cyst
Vascular Access – Long Axis of Vessel
45
Vascular Access – North Star Sign
Carpal Tunnel – Median Nerve
46