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PART III – New Paradigms for Ultrasound: Why MSK ?



The future is always coming up with surprises for us, and the best way to insulate yourself from these surprises is to diversify.Robert J. Shiller, American economist and Nobel Laureate

specializationAnyone who sits down with a financial/investment planner will be familiar with the advice surrounding diversification of assets.  “Don’t put all your eggs in one basket”, as the old saying goes, and that advice is equally valid for your “career capital” assets.  Success and job security in a sonographer’s career similarly corresponds to diversifying skillsets through adding registry certifications in multiple specialties.

However, it is an uncomfortable truth that not everyone keeps tabs on the latest innovations in their professional field.  Some lawyers, for example, still maintain a preference for the yellow legal pad over the iPad.  Thankfully, more professionals within our industry are responsive to rapid advancements in technology.  Still, you have likely been forced to navigate around co-workers and supervisors holding a “that’s how we’ve always done it” mentality often enough to understand that your enthusiasm for new technology and practices may not be universally embraced.

I make this point to highlight two inharmonious factors influencing the growth and availability of MSK ultrasound practitioners:

1) Many facilities ARE interested in performing MSK ultrasound, but do not have sonographers with the requisite skills.

2) Because MSK ultrasound is a fairly new ultrasound specialty, most ultrasound training programs do not include it in their curriculum.

The consequence of this is that demand is growing for MSK professionals without a broad infrastructure of schools teaching it.  The aforementioned lack of formal training in the field of MSK compels sonographers to learn either on the job or from independent study.  I was very fortunate to be mentored by Dr. Greg Wilde, an MSK fellowship trained radiologist.  Regrettably, most aspiring sonographers do not have the luxury of working side-by-side with a physician trained in MSK ultrasound.

When I discovered a dearth of educational material covering MSK ultrasound in sufficient depth for a beginner to become proficient, I decided to create my own “How to” manual for the specialty.  This resulted in Musculoskeletal Ultrasound: A Comprehensive Guide to MSK Imaging and Interventional Techniques.


msk-text-3I composed the material to be foundational, built from the ground up so to speak, because I have always been passionate about understanding the fundamental principles of each specialty I have learned.  There are ten distinct sections covering the upper and lower extremities.  An anatomy review, indications and protocols specific to each extremity are presented.  The protocols introduce paired ultrasound images: one annotated image outlining anatomical structures and the other, a corresponding non-annotated image. The protocols include helpful Transducer Overlays, illustrating the ideal body positioning, noting Notch position and directional scanning guidance.

In addition to the specific extremity sections, the textbook covers the following subject matter in depth:

  • Soft Tissue & Pathology
  • Peripheral Nerves (covering 14 protocols distinct to specific peripheral nerve evaluations)
  • Ultrasound-guided Interventional Procedures (covering 23 protocols distinct to specific interventional procedures)

In closing, I welcome your feedback, and hope you share my enthusiasm for adding specializations to your resume.  It is an investment that will return dividends.

jamie-bie_photoJamie Bie is the Senior Musculoskeletal Ultrasound Specialist at Columbia University/New York Presbyterian Imaging. She was awarded the ARDMS Pioneer Musculoskeletal Ultrasound credential in 2012. In addition to holding the RMSKS credential, she is also registered in Vascular Technology, Abdomen, OB/GYN, and Breast. Jamie has written departmental protocols and has trained several physicians and sonographers in Musculoskeletal Ultrasound.

Jamie Bie is also the author of newly-released Musculoskeletal Ultrasound: A Comprehensive Guide to MSK Imaging and Interventional Techniques, a comprehensive, step-by-step guide to MSK Ultrasound. This textbook includes an overview of MSK Ultrasound physics, illustrated protocols, anatomy review by section, transducer and ultrasound overlays to clarify positioning and structure recognition, and CheckPoints noted throughout the text, providing critical technical tips.


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