Soundeffects news | Greg Curry (AUS)

Greg Curry (AUS)

Monash Health VASCULAR

Greg Curry is a senior sonographer at Monash Health in Melbourne where he has been the vascular ultrasound clinical lead for the network since 2013. Greg continues to be involved in education and training for vascular and general ultrasound across the Monash Health network, including the role of acting tutor sonographer in 2021. Greg has been a contributor at various state and national meetings and has a passion for vascular ultrasound, education and quality. Greg chats to us about the sonographer’s role in a team of medical professionals and his thoughts on networking and collaboration.

What are some of the challenges in finding the best way to apply ICA stenosis criteria?

Identifying and accurately quantifying ICA stenosis is a really important part of our job as sonographers, but it can be hard. I think the main challenge in applying stenosis criteria is educating sonographers to understand that even the best criteria have intrinsic limitations. Criteria provide a solid framework but there is a significant proportion of studies where velocity criteria are at risk of misleading sonographers and clinicians. Understanding secondary criteria such as ratios and B-mode diameter measurements and how to apply them is critical.

I think we all naturally like things to fit neatly into categories, but we need to understand and leave room for nuance in our worksheets and reports. While some of the limitations of carotid criteria are intrinsic, other variables can be reduced by things like using quality techniques, collaborating with peers and describing limitations clearly so clinicians can make the best decisions for the patient. Local auditing can also be useful to help apply the right criteria within your group.

What impact is it having on the sonographer and patient when there is no clear unified consensus for ICA stenosis criteria?

Often sonographers are oriented to certain criteria based on where they are trained and go on to adopt that method ongoing. They might rarely if ever consider that there are other criteria. Being presented with different criteria can confuse sonographers, but more importantly, if clinicians are getting reports from different institutions using different criteria it may lead to misunderstanding about when and how to manage patients. In the end, we want to make sure that high-risk patients who need invasive treatments are recognised to reduce their risk of stroke. At the same time, we don’t want to treat people who won’t benefit. Finding the balance is key.

What is the sonographer’s role in a haemodialysis team?

In my opinion, we play a really important role within the team, even if we aren’t aware of it. Haemodialysis is a life-saving process and it takes a wide range of specialists and clinicians to help maintain treatment. Sonographers are often asked to help identify problems in the fistulas of the most vulnerable dialysis patients. We can guide and direct treatments that can keep dialysis access going for them. A thrombosed fistula is a disaster for a patient, which invariably leads to hospital admission and painful invasive procedures or sometimes worse. If sonographers know how to recognise the markers for identifying a fistula that is at risk of thrombosing and take on the responsibility of forwarding that information back to the rest of the team, then we can have a big impact on patients.

What are the key takeaways from your workshop ‘Thoracic outlet ultrasound techniques: Bias beware’?

In my experience, thoracic outlet assessment is an examination that can lead to confusion and doubt. Every time I think I’m close to having it down pat, I soon find that it isn’t that easy. I’m lucky to often discuss cases with various clinicians and it seems to be difficult for them too. The main takeaways will be to recap the goals of the examination and how clinicians might use the information we give them. I’ll also attempt to give an example of how to approach the examination that might help provide a consistent approach. I’m hoping that I might learn something from my peers at the conference in the process too.

What are some of the challenges in diagnosing thoracic outlet syndrome?

It is a tricky area. The anatomy and pathophysiology are complex and like many examinations sonographers are faced with there are many variables. We are being asked to bring together clinical information and symptoms and describe functional and dynamic changes that can be technically challenging to perform. Confirmation bias can creep into how we identify and describe compression in and around the thoracic outlet. On top of that, there are different types of thoracic outlet syndromes and different types of clinicians requesting examinations who often have varying goals in treating their patients.

Why is ultrasound an important tool in diagnosing GCA? And what measures can be adopted to improve the diagnosis of GCA?

The value of ultrasound in diagnosing GCA is the combination of high resolution imaging and correlation with symptoms. Clinically diagnosing GCA involves a complex algorithm of information, and imaging can be very helpful in providing a final diagnosis one way or another. Biopsy has been the gold standard, but it is invasive and has poor sensitivity, and recent evidence has reinforced the need for ultrasound. By using good techniques and extending our protocol beyond basic temporal artery assessment, the ultrasound can help improve diagnostic accuracy and timely treatment.

Our conference theme this year is ‘Strength in Collaboration’. Can you share a positive experience where collaboration or networking played a crucial role in your professional journey?

I am fortunate to have many examples of collaboration which have helped in my professional development as a sonographer over the years. One of the best things about collaboration with other groups is the sharing of knowledge and I’ve learnt so much from radiologists, nurses, surgeons, clinicians, and others who have been generous enough to include me in multidisciplinary team meetings and clinical discussions. As sonographers, we are linked to so many different clinical areas and have a lot of knowledge and experience to contribute. While there are many examples, one of the most fulfilling to me has been my involvement with the haemodialysis team at Monash Health. Our sonographer group is highly valued, and we have contributed directly to improving protocols and patient pathways that help patients maintain lifesaving dialysis.