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New Paradigms for Ultrasound: Alzheimer’s Disease


Last month, I wrote a guest-blog based on my learning experience attending a program studying neuropsychiatry at Harvard last summer.  Thank you for the kind words of encouragement and support many of you have given me thus far.  It seeded the courage for me to complete this follow-up.

alzheimers-6Because, for me, ultrasound science is ‘the family business’ I had a natural desire to understand more about emerging technologies and applications in the field of medicine.  One area, in particular, that piqued my interest was Continue reading

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Frustrated StudentWhether you are trying to earn your first ultrasound credential, or adding a specialization, we can all agree that there isn’t much fun in sitting for the examination.  The nature of the exam lends itself to anxiety, because it is ‘PASS/FAIL’.  There are no Gold, Silver or Bronze medals … nor is there even a Participation Trophy.  It is a binary result (Win-Lose), and 2nd Place is equivalent to a loss.

Modern cultural emphasis on raising/maintaining self-esteem has rendered the word ‘failure’ unfashionable, like “He Who Must Not Be Named” from the Harry Potter novels.  While we can cosmetically ban the word from our discussion, its threat is emotionally real.  So, what’s a career-minded, aspiring ultrasound/sonographic professional left to do?


2018-sdms-sample-slideFor many years, Pegasus has labored compiling data from individuals and institutions to better prepare exam candidates for ultrasound credentialing and board exams.  Last fall, we again presented studies to the 2018 SDMS Annual Conference under the lecture title “ExamSim Data: A statistical look at what students do and don’t know!

The key ‘take-aways’ from this analysis are in identifying the  question content that test-takers trip up on most frequently, with the subsequent goal of fortifying their most likely weaknesses.  Interestingly enough, we build similar utilities into our ExamSim programs and our College Program Instructor Tool, both of which analyze content weakness, providing each student with an individualized plan to fine tune their exam preparation.

office-hours-graphicWe invite those intrigued with this subject matter to register for Pegasus Lectures February ‘Office Hours’, scheduled for NEXT WEEK, the 26th, 6 pm-7 pm CST.  We will step through the results and offer instructors and students real-world guidance on strategies to improve testing success.  This presentation is also approved for 1 SDMS CME credit hour. Advance Registration is required, but there is NO COST or obligation in attendance.


Pegasus Lectures has preached the word ‘Preparedness’ for over 25 years.   Our earliest marketing materials carry “Prepare with Pegasus, and Pass” as a catchphrase. Especially in the last decade, Pegasus has invested in the development of industry-leading Exam Sims and eCourses, steering away from outdated live-seminars in which you are forced to learn at the pace of the class.  With online learning, you dictate the pace and proceed only when you have mastered the concepts.   While Pegasus Lectures strives to provide programs that result in professional excellence and improved patient care, we never lose sight of the results-oriented goal: Getting you into the Winner’s Circle.

“Negative results are just what I want. They’re just as valuable to me as positive results.  I can never find the thing that does the job best until I find the ones that don’t.”  ― Thomas A. Edison

Frank Miele, MSEE , President of Pegasus Lectures, Inc.  Frank graduated cum laude from Dartmouth College with a triple major in physics, mathematics, and engineering. While at Dartmouth, he was a Proctor Scholar and received citations for academic excellence in comparative literature, atomic physics and quantum mechanics, and real analysis. Frank was a research and design engineer and project leader, designing ultrasound equipment and electronics for more than ten years at Hewlett Packard Company. As a designer of ultrasound, he has lectured across the country to sonographers, physicians, engineers and students on myriad topics.

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New Paradigms for Ultrasound: Essential Tremor


I grew up in a household where ultrasound technology or sonography was as likely a dinner-table topic as our individual school day routines. Both my parents work in this field and would often use ultrasound systems for teaching. This past summer, I attended a summer program at Harvard during which I studied neuropsychiatry. When asked to create a capstone presentation on a topic that dealt with the brain, I immediately gravitated toward ultrasound, a subject that has fascinated me since I was a young child. The following commentary is taken from that assignment and exercise.

garfieldIt is largely taken for granted that the primary value of ultrasound technology is its ability to probe inner organs and tissues without the use of an invasive scalpel or surgical instrument. It is hard to believe the advancements we have seen within my parents’ lifetime, and disturbing to discover what passed for medical assessment in the late 1800s and early 1900s.


Research & Regulatory Approval by Indication (Red: FDA Approval, Orange: Outside USA Approval, Yellow: Pilot Trials)

Nowhere is the
potential for
ultrasound technology as an alternative to invasive procedure more promising than in the field of neuroscience specific to the human brain. Rather obviously, it is very difficult organ to access. This makes sense anatomically because it is a very important organ, and one would expect that Nature wished it to be protected.

karl-duffIronically, while early pioneering research, by Dr. Karl Dussik of Austria in 1942, is based on experiments assessing brain physiology, the medical fields most impacted by sonography over the next 40-50 years (OB/GYN, Abdomen, Breast) were not brain-related. It is only recently this technology has reached trial/approval status in neurobiological fields.

One neurological disorder that emerging ultrasound technology offers promise to relieve is Essential Tremor. It is among the most commonly observed tremor disorders, although distinct from Parkinson’s Disease. Several million Americans are estimated to be suffering from this disease. Prior to 2016, when the United States FDA approved a focused ultrasound device for treatment of this condition, patients’ only alternatives were anticonvulsant medications or brain surgery. The surgical options being a permanent removal of brain tissue (thalamotomy) or the implantation of an electronic device to periodically shock the thalamus (deep brain stimulation). Both these options are considered invasive.



Specifically, with respect to cranial anatomy, focused ultrasound’s ability to excise tissue without disturbing the integrity of the scalp and skull offers great hope to those cruelly afflicted by convulsive disorders. Previous blog posts have noted that the future promise for ultrasound treatment versus surgical intervention rests on its precision and non-invasive qualities. The potential applications are only beginning to be imagined.

In two weeks, I will follow up this discussion with the potentials being studied for the treatment of Alzheimer’s Disease with ultrasound technology.

Gina Miele is the daughter of Frank Miele, MSEE , President of Pegasus Lectures, Inc. and Carol Miele, RN, RVT, RDCS, FSVU, Vice President.  She attends high school in Dallas, Texas as a Junior at The Hockaday School.

*** A Special ‘Thank You‘ to Focused Ultrasound Foundation for use of images, statistical and industry research.

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