Soundeffects news | Jane Keating (AUS)

Jane Keating (AUS)

Royal Melbourne Hospital GENERAL

Jane Keating is currently an ultrasound clinical educator at Royal Melbourne Hospital. As well as helping organise the conferences of ASUM and WFUMB, she has been involved with organising ASA conferences. She has presented at various national conferences as well as travelling workshops and education evenings. She has co-authored two book chapters on Portal hypertension and transplant renal Dopplers for inside ultrasound: Vascular Reference Guide. Jane was awarded the ASA Pru Pratten Memorial Lifetime Achievement Award in 2006. We asked Jane about emerging technologies in her field, how to bridge the gap between those technologies and traditional methods, as well as who she is most excited to see present at ASA2024.

Can you outline some of the key advantages in contrast-enhanced ultrasound of the liver over some other image modalities like MRI or CT?

Contrast-enhanced ultrasound (CEUS) is an amazing tool that we have been lucky enough to use at Royal Melbourne Hospital (RMH) since 2007. This has been an integral part of the daily service that the RMH ultrasound department provides.

There are many advantages of CEUS over other imaging modalities, and the textbook advantages are that it avoids radiation, it is not nephrotoxic and it can be performed at the bedside. One of the more important advantages is that there is less risk of an adverse reaction to the ultrasound contrast media than CT or MRI, and there are fewer contraindications. The patients tend to tolerate CEUS very well, and we have had very few reactions with our patients at RMH over the last 17 years.

CEUS is also unique in that we can see vascularisation and perfusion of lesions in real-time, and from the dynamic assessment of these enhancement patterns in all phases (arterial, portal venous, and late phase) we can characterise liver lesions or determine if a renal cyst is simple or complicated. CEUS has high spatial resolution and has been proven to be equal, if not better than CT, and is good at diagnosing small lesions.

These are all advantages that you can find on the internet. For me, the most amazing advantage is when you can give instantaneous peace of mind to anxious patients who have been told they have a lesion, and their minds have instantly conjured up that they have cancer. At RMH we often perform CEUS on incidentally found lesions and the radiologist can reassure them while they are there that it is benign without having to do any further tests. This is the most rewarding part of being able to be involved with CEUS.

How do advancements in technology and operator experience influence the reliability and accessibility of liver elastography for assessing fibrosis and cirrhosis in patients with chronic liver disease?

Liver shearwave elastography has been around for the last 15 years and we have been utilising this technology at RMH since 2012.

The use of shearwave has grown rapidly, and with vast research and improved technology, it has become more readily accepted by referrers as an accurate method of fibrosis scoring for patients with chronic liver disease. With the increasing demand for the management of these patients, it is now a tool found in many radiology practices, whether they be in the public or private sectors.

Elastography accuracy can be very operator-dependent, and it isn’t an examination that you can attempt without training, and this is a crucial factor in improving interobserver reproducibility. Before sonographers begin using elastography, it is important to be educated and learn from colleagues who are experienced, or by engaging in webinars or workshops to understand the technology and the protocols required. I encourage everyone to enrol in webinars and online learning videos by Marilyn Zelesco on this topic.

By increasing the availability of this non-invasive tool in clinical practice, and with the increasing confidence of referrers, elastography has led to a reduced number of liver biopsies that need to be performed.

How can sonography students effectively bridge the gap between traditional techniques and emerging technologies in the field?

I love teaching ultrasound trainees and imparting my knowledge of experience, although we need to keep in mind that we can also learn and be challenged through their learning journey. The university content today is so different compared to the ‘olden days’ (as my children call it) when one of our assignments was on how a lightbox worked! Post and undergraduate ultrasound curricula have advanced greatly over the years, and the content includes ever-evolving new technologies, such as elastography and CEUS, which are considerably more important things than the extinct lightbox.

Clinical educators are always on their toes, and one of the challenges is always making sure they are one step ahead of their students. Trainees remind us that ultrasound requires the mindset of lifelong learning, and remaining open to exploring new ideas and experimenting with new techniques and technologies. Educating trainees encourages us to push the boundaries in the workplace, and adapt to the latest advancements in technologies as they emerge, which enables us to deliver high quality patient care.

I must also point out that ultrasound trainees are also very important when you need computer-related problems fixed!

As a seasoned and well-respected sonographer, who are you most excited to see present at ASA2024?

This is a difficult question, as there are so many amazing speakers in the excellent program. I am very keen to attend the general sessions, as we are always up for learning something new in the staple examinations that we perform. I am excited that we have Adrian Lim as one of our international guest speakers. He is one not to be missed.

I also have a few favourites who are the oldies but the goodies: Louise Worley, Greg Curry, Gillian Profaca, Frauke Lever and Andrew Grant. For entertainment and education, you can’t go past Peter Russel, Paula King, Stephen Bird, and the legendary Coombsy (Peter Coombs).

Presenting is very rewarding, as well as self-educating, and while I love the oldies but the goodies, I would love to see young sonographers venturing into the world of education at future conferences. Go on, do it!