Unlocking a New Paradigm for Healthcare

James Day: Hello and welcome to the Point-of-Care Ultrasound Certification Academy podcast where we focus on POCUS. Here we will discuss all things related to point-of-care ultrasound, the practice, the trends, and its impact on healthcare. Our program will engage thought leaders who are defining global patient care with the stethoscope of the future.

James Day: James Day here today recording live from the Focus on POCUS studio. Today, we have Dr. David Dawson as our guest. Dr. Dawson specializes in vascular and endovascular surgery currently with Baylor Scott and White Health in central Texas. His clinical practice includes carotid artery disease, aortic aneurysm repair, and treatment of mesenteric and renal artery disease, venous disorders, diabetic foot problems, and other complex circulatory disorders. He is internationally recognized for his research and expertise with peripheral artery disease. He is a decorated airforce veteran who before joining the faculty at UC Davis worked at NASA as chief of the medical science division at the Johnson Space Center in Houston, Texas. His expertise in aviation and space medicine compliments his interest in applying advanced technologies including simulation to healthcare. He has written numerous journal articles and book chapters, frequently lectures at both national and international conferences, and serves in leadership roles in regional and national professional societies. Dr. Dawson is also known for roles in surgical education including founding program director for the Vascular Surgical Residency and Fellowship at UC Davis where he was in practice from 2002 to 2018.

James Day: All right, Dr. Dawson glad to have you here today.

David Dawson: James, it’s great to be here.

James Day: How is everything?

David Dawson: Things are good. Things are good. Things are always busy and things are always changing, so looking forward to talking about POCUS today.

James Day: Well, we’ll toss the four questions right at ya.

David Dawson: Okay.

James Day: The first one, can you elaborate on how the practice of point-of-care ultrasound is utilized in the application of surgery? I’d really like to hear the surgery side.

David Dawson: You know, there’s really so many aspects of surgery. Surgeons are diagnosticians. You can’t operate unless you have a diagnosis, and sometimes physical exam is just not enough. POCUS can be an extension of physical examination. Surgeons can use ultrasound in the operating room for intraoperative assessments, and we commonly use as vascular surgeons point-of-care ultrasound for procedural guidance.

James Day: That’s great. Yeah, I’m really interested in your tenure at the Johnson Space Center in Houston, Texas, and just thinking here, do you have any stories on the application of POCUS in aviation and simulation?

David Dawson: Well, I mean just to approach that a little bit more broadly, point-of-care ultrasound is a great tool for what we call operational medicine. We have to take medical capabilities out of the hospital and provide care to support combat operations, humanitarian relief operations, and space medicine. You can’t take a CT scanner with you quite as easily as you can take point-of-care ultrasound.

David Dawson: And so the space agency was interested in applications of diagnostic ultrasound in space medicine, both from a research perspective and from potentially a clinical perspective. How to take care of somebody on long-duration space missions who might not have easy access to terrestrial healthcare.

David Dawson: But the issues are the same in aviation and operational medicine, space medicine, you have a limited amount of power, bandwidth, space, and weight that you can carry. Point-of-care ultrasound is portable, and it can be used in a variety of different ways. It’s really an effective tool.

David Dawson: I guess one of the interesting experiences I had is being part of a team of researchers who were validating ultrasound applications for potential space medicine uses and flying in a KC-135 and microgravity parabolic flight profiles to test what was essential a trauma FAST exam but doing that in zero G. A little bit unusual.

James Day: Yeah, I’ll say. I think I’ve seen pictures of astronauts using tiny ultrasound devices before.

David Dawson: You bet. There’s been, a variety of different ultrasound modalities have been flown on space shuttle research missions, and they have installed ultrasound system as part of the U.S. lab on the international space station.

James Day: Yeah. Now POCUS is pretty much like anything else in medicine. We have no perfect tools because we’re working with a hypercomplex system with many variables, and I just wondered with your extensive experience, do you have any thoughts as to refining this process?

David Dawson: Well, it’s really changing the paradigm. I mean, we’ve been evolving ultrasound applications for decades, and in the United States practice, ultrasound has been a tool for an ultrasound professional and for imaging professionals. In many other countries, the provider who does the ultrasound examination is the interpreting physician. We do it a little bit differently here in the United States where we have trained technologists. But POCUS is really putting the tool back in the hand not only of the doctor or the clinician but really of the person whose going to be making the decisions about the patient.

David Dawson: Now, what that means is it takes ultrasound and puts it in the hand of someone who’s not an ultrasound professional doing scanning and imaging full time 40 plus hours a week. It’s putting it in the hands of people who are using it in the context of clinical practice. And we use it a little bit differently. We typically use it to answer a specific question, a yes/no do I follow one diagnostic pathway or another? Do I need to get more sophisticated imaging or can I put the question aside?

David Dawson: Really what we’re doing with POCUS is we’re changing the way we use ultrasound, and it’s really having a significant impact on the practice of multiple specialists.

James Day: Very good. Excellent. Another question that came to mind when you were telling me that, I like the way you define that process. It was like a clinical pathway there, but what are some of the common myths that we hear that surround the practice of point-of-care ultrasound?

David Dawson: Well, I’m not sure there are any myths. I think there’s different perspectives. This is like the blind man and the elephant and they’re each feeling and seeing with the feeling and perceiving being a different part of the elephant. What I think we need to understand is diagnostic ultrasound, like any tool, requires a certain amount of training, understanding of the principles, familiarity with the clinical applications, and some, I think, help along the way to make sure the people are learning to do it the right way.

David Dawson: I don’t think anyone’s born just able to do it. On the other hand, you don’t need to be able to answer every possible ultrasound-related question to be able to use POCUS effectively. If you can find the structure you’re looking for, you can image it, you can see it, and you can make a decision about whether it’s normal or abnormal. Then that’s very useful in clinical practice. You don’t have to know everything to move forward, but sometimes we have a fork in the road that POCUS can help with.

James Day: Very good. As a parting shot here today, and I’d like to thank you for taking the time to be with us today on the show. It’s honor to have you on our inaugural podcast here. As a surgeon, do you have maybe a great case that involves point-of-care ultrasound? One that stands out in your mind?

David Dawson: Well, I use point-of-care ultrasound every time I do a procedure because essentially every endovascular procedure where I put a needle into a vein or artery, I do it with ultrasound guidance so I’m using it all the time in certain applications. But I also use it in the clinic. And I remember recently I had a patient come who I had treated about six months prior for a large symptomatic aneurysm of his abdominal aorta, and he had come to the emergency room, we had cared for him, we had done the procedure without complication, he had gone home the next day. And he came back initially for followup a few weeks later, and then I’m seeing him six months later. The reason I’m seeing him six months later is because the standard is to get surveillance imaging after doing an endovascular aneurysm repair, an EVAR.

David Dawson: And this guy had insurance that made that difficult. They put up barriers, and he didn’t get his CT scheduled. He didn’t get the ultrasound scheduled. He couldn’t get any imaging done prior to the visit, and he came from two hours away. He comes into the clinic, he’s doing fine, but what I really needed to do was find out if he had an endoleak or a late complication of the endovascular aneurysm repair procedure.

David Dawson: Well, I wasn’t going to do a full EVAR study because that would take an ultrasound technologist well over an hour to do. We actually blocked about two hours for his complete examination, but because I had POCUS I could see him, I could evaluate him, I could put the transducer on his abdomen, and I saw that the size of his aneurysm had gone from 7 to 5.5 cm in diameter over the six months since the procedure, and I knew from that fact alone that he didn’t have a large endoleak or clinically significant endoleak.

David Dawson: I could evaluate the flow in the femoral arteries bilaterally normal. Really I had ruled out by clinical assessment and about a minute of ultrasound any of the likely complications of EVAR that we had to worry about. I didn’t have to worry about a delay in this guy getting a CT scan. We could say well we can get that done whenever your insurance company is ready because now we knew that he was not in this high-risk category.

David Dawson: I really took it from a situation where I might have to have him back next week or something that was inconvenient for him to something that could be scheduled electively in a fashion that the health system could accommodate. It made it a lot better for the patient, I could reassure him, I could send him out with the knowledge that had been appropriately and effectively treated and there really wasn’t anything to worry about. He stills needs long-term surveillance with imaging, but we didn’t have to have him do an extra day of driving back and forth to get something taken care of right away.

James Day: That’s great. Not only navigating the actual pathology of the case, you’re navigating the whole insurance which is always a challenge in the hospital. That’s great. You touched on several good topics there that are very current.

James Day: Listen, Dr. Dawson, awesome work. Great stuff. You’re a man of many talents and thanks a lot.

David Dawson: It’s an honor to be a part of this, James. Thanks for having me on your program.

James Day: We hope you enjoyed today’s podcast, Focus on POCUS. Be sure to tune in with us next week for more interviews with thought leaders that are on the forefront of global point-of-care ultrasound.